pediatrics
BRUE
Key Points
BRUE (brief, resolved, unexplained event) is defined as an episode of cyanosis or pallor, abnormal breathing, abnormal muscle tone, or altered responsiveness in an infant < 1 year old, with no identifiable cause, and based on the clinician’s characterization of the event and not on a caregiver’s perception that the event was life-threatening. Infants who experience a BRUE can be classified as low-risk or high-risk based on history and physical examination. Events in low-risk infants are unlikely to be due to a serious medical condition and require minimal assessment. High-risk events have many possible causes, but often no etiology is found. Respiratory, neurologic, infectious, cardiac, metabolic, and gastrointestinal disorders as well as abuse should be considered, with testing done based on clinical findings. Infants with abnormal examination findings or laboratory results or who required intervention or had a worrisome history are hospitalized. Treatment is directed at the cause; home monitoring may be done but has not been shown to decrease mortality. Prognosis depends on cause; risk of death is increased in children with a neurologic disorder, who have had 2 or more events, who have experienced nonaccidental trauma, or who are > 6 months and have had an event of longer duration, especially if they have heart disease. 