pediatrics
BRUE
Introduction
BRUE (brief, resolved, unexplained event) is an episode of cyanosis or pallor, abnormal breathing, abnormal muscle tone, or altered responsiveness in infants. A previous term for similar events was ALTE (apparent life-threatening event). BRUE is not a specific disorder and is diagnosed only when no other cause is identified for a qualifying event. BRUE (brief, resolved, unexplained event) is not a specific disorder, it is a term to describe a sudden, brief, and now resolved episode of the appearance of altered hemodynamic status and responsiveness in an infant. , BRUE replaced the term ALTE (apparent life-threatening event), which was thought to be overly broad and alarming to caregivers ( References ) and may have resulted in unnecessary medical testing. BRUE is defined slightly differently than previous terms; the diagnosis requires the child to be < 1 year old; the event to have no other likely explanation; and the diagnosis to be based on the clinician’s characterization of features of the event and not on a caregiver’s perception that the event was life-threatening. Some infants have a transient event involving some combination of altered respiration, consciousness, muscle tone, and/or skin color. This is alarming for caregivers—some of whom may fear that they are observing a life-threatening event and may even begin doing cardiopulmonary resuscitation (CPR). Although a small minority of these infants are found to have a significant underlying disorder, among infants who appear well after this type of episode, a large number do not have recurrences or complications and go on to develop normally ( References ). BRUErefers to events lasting < 1 minute in an infant < 1 year of age that are associated with ≥ 1 of the following: Absent, decreased, or irregular breathing Cyanosis or pallor Altered level of responsiveness Marked change in muscle tone (hypertonia or hypotonia) In addition, infants must otherwise appear well and be back at their baseline state of health after the event. Thus, infants who are febrile, coughing, or showing any signs of distress or other abnormalities arenotconsidered to have had a BRUE. The term BRUE appliesonlyto events for which there is no underlying cause (hence "unexplained"), which can be determined only after a thorough history and physical examination and sometimes testing and a period of observation. For infants with a similar presentation in whom a causewasidentified, clinicians should identify a diagnosis for the episode based on the underlying cause. 