pediatrics
BRUE
Evaluation of BRUE
Evaluation of infants with any other manifestations besides those defined as BRUE is described elsewhere (see, for example, Cough in Children , Evaluation of an event initially involves a thorough history, including Observations by the caregiver who witnessed the event, particularly a description of changes in breathing, color, muscle tone, and eyes; noises made; length of episode; and any preceding signs such as respiratory distress or hypotonia Interventions performed (eg, gentle stimulation, mouth-to-mouth breathing, CPR) Prenatal (maternal) or current caregiver use of medications, tobacco, alcohol, or illicit substances Information about the infant’s birth (eg, gestational age, perinatal complications) Feeding habits (whether gagging, coughing, vomiting, or poor weight gain has occurred) Physical Growth of Infants and Children and Prior events, including recent illness or trauma Recent exposure to infectious illness Family history of similar events, early deaths, Torsades de Pointes Ventricular Tachycardia or other arrhythmias, or possible causative disorders Physical abuse should be sensitively assessed. Recurrent events that are concerning for abuse include those where the examination findings do not match the history and the event occurs only in the presence of a caretaker. Because disposition depends in part on family capabilities and resources, it is also important to assess the housing and family situation, the level of caregiver anxiety, and whether the infant has ready access to follow-up medical care. Physical examination is done to check for abnormal vital signs, respiratory signs, obvious malformations and deformities, neurologic abnormalities (eg, posturing, inappropriate head lag), signs of infection or trauma (particularly including retinal hemorrhage on funduscopy), and Physical abuse . Possible BRUEs are classified as low or high risk based on history and physical examination. Low-risk infantsare those who meet the following criteria: Age > 60 days Gestational age at birth ≥ 32 weeks and post-conceptual age ≥ 45 weeks One event only, no prior BRUE and no cluster of BRUEs No CPR required by trained medical provider No features of concern in history (eg, concern for child abuse, family history of sudden death) Normal physical examination (eg, afebrile, normotensive) Low-risk infants are very unlikely to have a serious underlying disorder, and the2016 guidelinesrecommend few or no interventions other than caregiver education. High-risk infantsinclude all those who do not meet low-risk criteria. The current guidelines do not contain recommendations for their evaluation and management, so evaluation and management should be based on the history and findings in the infant. Forlow-risk infants,guidelines recommend minimal testing. It is reasonable to observe the infant (including monitoring pulse oximetry) in the emergency department or office for a brief period and do 12-lead ECG and testing nasopharyngeal swab for pertussis (culture or PCR). Other tests, including imaging studies and blood tests, are not necessary. Routine hospital admission also is not necessary; however, infants may be hospitalized for cardiorespiratory monitoring if caregivers are extremely anxious or are unable to bring the infant for follow-up in 24 hours. Forhigh-risk infants,laboratory and imaging tests are done to check for possible causes. Some tests are done routinely and others should be done based on clinical suspicion of a specific etiology of the episode (see table), including whether the infant is still symptomatic or has required medical intervention. Infants are often hospitalized for cardiorespiratory monitoring, particularly if they required resuscitation or if evaluation detected any abnormalities. 