Apparent Life-threatening Events Research Articles

Brief resolved unexplained events: a new diagnosis, with implications for evaluation and management.

Brief resolved unexplained events (BRUE) are concerning episodes of short duration (typically < 1min) characterized by a change in breathing, consciousness, muscle tone (hyper- or hypotonia), and/or skin color (cyanosis or pallor). The episodes occur in a normal-appearing infant in the first year of life, self-resolve, and have no readily identifiable explanation for the cause of the event. Previously called apparent life-threatening events (ALTE), the term BRUE was first defined by the American Academy of Pediatrics (AAP) in 2016. The criteria for BRUE carry greater specificity compared to that of ALTE and additionally are indicative of a diagnosis of exclusion. While most patients with BRUE will have a benign clinical course, important etiologies, including airway, cardiac, gastrointestinal, genetic, infectious, neurologic, and traumatic conditions (including nonaccidental), must be carefully considered. A BRUE is classified as either lower- or higher-risk based on patient age, corrected gestational age, event duration, number of events, and performance of cardiopulmonary resuscitation at the scene. The AAP clinical practice guideline provides recommendations for the management of lower-risk BRUEs, advocating against routine admission, blood testing, and imaging for infants with these events, though a short period of observation and/or an electrocardiogram may be advisable. While guidance exists for higher-risk BRUE, more data are required to better identify proportions and risk factors for serious outcomes among these patients. Conclusion: BRUE is a diagnosis with greaterspecificity relative to prior definitions and is now a diagnosis of exclusion. Additional research is needed, particularly in theevaluation of higher-risk events. Recent data suggest that the AAP guidelines for the management of lower-risk infants can besafely implemented.This review article summarizes the history, definitional changes, current guideline recommendations, and future research needs for BRUE. What is Known: • BRUE, first described in 2016, is a diagnosis used to describe a well-appearing infant who presents with change in breathing, consciousness, muscle tone (hyper- or hypotonia), and/or skin color (cyanosis or pallor). • BRUE can be divided into higher- and lower-risk events. Guidelines have been published for lower-risk events, with expert recommendations for higher-risk BRUE. What is New: • BRUE carries a low rate of serious diagnoses(< 5%), with the most common representing seizures and airway abnormalities. • Prior BRUE events are associated with serious diagnoses and episode recurrence.

Accuracy of Diagnostic Codes for Identifying Brief Resolved Unexplained Events.

To evaluate International Classification of Diseases, 10th Revision (ICD-10) coding strategies for the identification of patients with a brief resolved unexplained event (BRUE). Multicenter retrospective cohort study, including patients aged <1 year with an emergency department (ED) visit between October 1, 2015, and September 30, 2018, and an ICD-10 code for the following: (1) BRUE; (2) characteristics of BRUE; (3) serious underlying diagnoses presenting as a BRUE; and (4) nonserious diagnoses presenting as a BRUE. Sixteen algorithms were developed by using various combinations of these 4 groups of ICD-10 codes. Manual chart review was used to assess the performance of these ICD-10 algorithms for the identification of (1) patients presenting to an ED who met the American Academy of Pediatrics clinical definition for a BRUE and (2) the subset of these patients discharged from the ED or hospital without an explanation for the BRUE. Of 4512 records reviewed, 1646 (36.5%) of these patients met the American Academy of Pediatrics criteria for BRUE on ED presentation, 1016 (61.7%) were hospitalized, and 959 (58.3%) had no explanation on discharge. Among ED discharges, the BRUE ICD-10 code alone was optimal for case ascertainment (sensitivity: 89.8% to 92.8%; positive predictive value: 51.7% to 72.0%). For hospitalized patients, ICD-10 codes related to the clinical characteristics of BRUE are preferred (specificity 93.2%, positive predictive value 32.7% to 46.3%). The BRUE ICD-10 code and/or the diagnostic codes for the characteristics of BRUE are recommended, but the choice between approaches depends on the investigative purpose and the specific BRUE population and setting of interest.

Defining Risk Factors for Children Following a BRUE: The Need to Revisit the AAP BRUE Guideline.

Defining Risk Factors for Children Following a BRUE: The Need to Revisit the AAP BRUE Guideline.

Risk Factors and Outcomes After a Brief Resolved Unexplained Event: A Multicenter Study

The accuracy of the risk criteria for brief resolved unexplained events (BRUEs) from the American Academy of Pediatrics (AAP) is unknown. We sought to evaluate if AAP risk criteria and event characteristics predict BRUE outcomes. This retrospective cohort included infants <1 year of age evaluated in the emergency departments (EDs) of 15 pediatric and community hospitals for a BRUE between October 1, 2015, and September 30, 2018. A multivariable regression model was used to evaluate the association of AAP risk factors and event characteristics with risk for event recurrence, revisits, and serious diagnoses explaining the BRUE. Of 2036 patients presenting with a BRUE, 87% had at least 1 AAP higher-risk factor. Revisits occurred in 6.9% of ED and 10.7% of hospital discharges. A serious diagnosis was made in 4.0% (82) of cases; 45% (37) of these diagnoses were identified after the index visit. The most common serious diagnoses included seizures (1.1% [23]) and airway abnormalities (0.64% [13]). Risk is increased for a serious underlying diagnosis for patients discharged from the ED with a history of a similar event, an event duration >1 minute, an abnormal medical history, and an altered responsiveness (P < .05). AAP risk criteria for all outcomes had a negative predictive value of 90% and a positive predictive value of 23%. AAP BRUE risk criteria are used to accurately identify patients at low risk for event recurrence, readmission, and a serious underlying diagnosis; however, their use results in the inaccurate identification of many patients as higher risk. This is likely because many AAP risk factors, such as age, are not associated with these outcomes.

Cytotoxic lesions of the corpus callosum in children: Etiology, clinical and radiological features, and prognosis

ObjectivesCytotoxic lesions of the corpus callosum (CLOCCs) are secondary lesions associated with entities like infection manifested by restricted diffusion on diffusion-weighted cranial magnetic resonance imaging. Our objectives are to evaluate the clinic-radiological spectrum of pediatric patients with cytotoxic lesions of the corpus callosum (CC). MethodsChildren (0–18 years) admitted between February 2017 and May 2020 with splenial lesions showing diffusion restriction on MRI, either isolated or within involvement of other parts of the brain, were included retrospectively. The primary lesions of the CC (e.g. acute disseminated encephalomyelitis, acute ischemic infarction, and glioblastoma multiforme) were excluded. CLOCCs were divided into infection-associated, metabolic disorder–associated, and trauma-associated lesions, as well as CLOCCs involving other entities. Data were collected from the medical databases. ResultsForty-one patients were determined to have CLOCCs. Twenty-five (61%) were infection-associated, nine (22%) were trauma-associated, and three (7%) were metabolic disorder–associated cases, including 2 inherited disorders of metabolism. There were four (10%) patients with other entities, three with epilepsy, and one had an apparent life-threatening event. Six patients had a known etiology among the infection-associated group; one had multisystem inflammatory syndrome caused by COVID-19 and one had been infected by COVID-19 without any complications. All the infection-associated patients with isolated splenial lesions recovered totally, although six patients required intensive care hospitalization. Four trauma-associated patients had sequela lesions. ConclusionsCLOCCs are associated with a spectrum of diseases, including the new coronavirus, COVID-19 infection. Infection-associated CLOCCs has the best prognosis, although severe cases may occur. Sequelae are possible based on the etiology.

Relationship between laryngomalacia and sleep-related breathing disorders in infants with brief resolved unexplained events

Introduction: Brief resolved unexplained events (BRUE) occur during infancy. It is characterized by one or more symptoms, including skin color change, shortness of breath and unresponsiveness. Laryngomalacia is the most frequent cause of stridor in infants and results in the collapse of the supraglottic structures during inspiration and intermittent obstruction of the upper airways. To our knowledge, the relationship between BRUE and laryngomalacia has been little investigated. Methods: The medical records of 448 children (age < 12 months) treated for BRUE between July 2011 and March 2018 and followed up until March 2020 were retrospectively reviewed. Endoscopic evaluation was performed using a flexible fibrolaryngoscope. All patients underwent a brief polysomnography and 24-h cardiorespiratory monitoring. Cardiorespiratory and oxygen saturation monitoring was continued at home; 94% of patients underwent follow-up. Results: Laryngeal fiberoptic endoscopy revealed laryngomalacia in 11% of children with a clinical history of BRUE. Laryngomalacia was associated with obstructive/mixed apnea in 67%. Home cardiorespiratory monitoring showed a gradual reduction in the number of respiratory events during follow-up and complete resolution of laryngomalacia in 88% of patients. Conclusions: This is the first report that showed follow-up data from cases of BRUE with laryngomalacia. The improvement in laryngomalacia alone, although not complete, was sufficient to improve obstructive events.

Laryngomalacia, GER, and sleep apnea are BRUEing – Sometimes!

Brief resolved unexplained events (BRUE) constitute the newest nomenclature of near-miss SIDS, later on termed ALTE. These events have been putatively assigned to the sleeping state and suspected to involve airway obstruction. The current study in the Journal (Nosetti et al., 2021, https://doi.org/10.7363/100207) identifies laryngomalacia and gastroesophageal reflux as being frequently associated with BRUE. The potential implications of such associations are discussed.

EP209 - Expanding the phenotype of HNRNPU-related disorders to include brief, resolved, unexplained events (BRUE)

eP209 - Expanding the phenotype of HNRNPU-related disorders to include brief, resolved, unexplained events (BRUE)

A Common 3'UTR Variant of the PHOX2B Gene Is Associated With Infant Life-Threatening and Sudden Death Events in the Italian Population.

Heterozygous mutations in the Paired like homeobox 2b (PHOX2B) gene are causative of congenital central hypoventilation syndrome (CCHS), a rare monogenic disorder belonging to the family of neurocristopathies and due to a defective development of the autonomic nervous system. Most patients manifest sudden symptoms within 1 year of birth, mainly represented by central apnea and cyanosis episodes. The sudden appearance of hypoxic manifestations in CCHS and their occurrence during sleep resemble two other unexplained perinatal disorders, apparent life-threatening event (ALTE) and sudden and unexpected infant death (SUID), among which the vast majority is represented by sudden infant death syndrome (SIDS). Differently from CCHS, characterized by Mendelian autosomal dominant inheritance, ALTE and SIDS are complex traits, where common genetic variants, together with external factors, may exert an additive effect with symptoms likely manifesting only over a “threshold.” Given the similarities observed among the three abovementioned perinatal disorders, in this work, we have analyzed the frequency of PHOX2B common variants in two groups of Italian idiopathic ALTE (IALTE) and SUIDs/SIDS patients. Here, we report that the c*161G>A (rs114290493) SNP of the 3′UTR PHOX2B (i) became overrepresented in the two sets of patients compared to population matched healthy controls, and (ii) associated with decreased PHOX2B gene expression, likely mediated by miR-204, a microRNA already known to bind the 3′UTR of the PHOX2B gene. Overall, these results suggest that, at least in the Italian population, the SNP c*161G>A (rs114290493) does contribute, presumably in association with others mutations or polymorphisms, to confer susceptibility to sudden unexplained perinatal life-threatening or fatal disorders by increasing the effect of miR-204 in inducing PHOX2B expression down-regulation. However, these are preliminary observations that need to be confirmed on larger cohorts to achieve a clinical relevance.

Management of Infants with Brief Resolved Unexplained Events (BRUE) and Apparent Life-Threatening Events (ALTE): A RAND/UCLA Appropriateness Approach.

Unexpected events of breath, tone, and skin color change in infants are a cause of considerable distress to the caregiver and there is still debate on their appropriate management. The aim of this study is to survey the trend in prevention, decision-making, and management of brief resolved unexplained events (BRUE)/apparent life-threatening events (ALTE) and to develop a shared protocol among hospitals and primary care pediatricians regarding hospital admission criteria, work-up and post-discharge monitoring of patients with BRUE/ALTE. For the study purpose, a panel of 54 experts was selected to achieve consensus using the RAND/UCLA appropriateness method. Twelve scenarios were developed: one addressed to primary prevention of ALTE and BRUE, and 11 focused on hospital management of BRUE and ALTE. For each scenario, participants were asked to rank each option from ‘1’ (extremely inappropriate) to ‘9’ (extremely appropriate). Results derived from panel meeting and discussion showed several points of agreement but also disagreement with different opinion emerged and the need of focused education on some areas. However, by combining previous recommendations with expert opinion, the application of the RAND/UCLA appropriateness permitted us to drive pediatricians to reasoned and informed decisions in term of evaluation, treatment and follow-up of infants with BRUE/ALTE, reducing inappropriate exams and hospitalisation and highlighting priorities for educational interventions.

Achondroplasia is associated with increased occurrence of apparent life-threatening events.

To assess the clinical picture underlying apparent life-threatening events (ALTEs) occurring in infants with achondroplasia and provide guidance for evaluation after an event. A population of 477 individuals with achondroplasia was retrospectively reviewed, and information regarding possible ALTEs was recorded in a REDCap database. ALTEs occurred in the first year of life in 18 of 477 individuals (3.8%). Most (14/18, 78%) occurred in the first 6months of life and presented as episodes of apnoea and/or seizures. Of affected infants, 8/18 (44%) had more than one episode. Many of the initial ALTEs arose while infants were in car seats (11/18, 61%). Assessment following ALTEs most often demonstrated either craniocervical junction concerns and/or seizures, with 12/18 (67%) patients undergoing cervicomedullary decompression and 5/18 (28%) starting on anti-epileptic medications after the event. Although this study is limited in size and was retrospective, it shows that infants with achondroplasia appear to be at high risk for ALTEs. Evaluation after an event should include neuroimaging of the foramen magnum, inpatient hospital observation including respiratory monitoring and electroencephalography, and a car seat challenge.

The Role of Combined Multichannel Intraluminal Impedance-pH Monitoring in Infants with Brief, Resolved, Unexplained Events.

PurposeData on the relationship between gastroesophageal reflux (GER) and brief resolved unexplained events (BRUE) in infants is scarce. The aim of this study was to identify the characteristics of combined multichannel intraluminal impedance-pH (MII-pH) monitoring in infants who have experienced BRUE.MethodsWe conducted a prospective study of infants who were hospitalized on account of BRUE and required 24-hour MII-pH monitoring.ResultsTwenty-one infants (mean age, 4.7 months; range, 0.9–8.9 months; male/female, 11/10) participated in this study. BRUE symptoms associated with GER were found in 10 infants (47.6%). Based on the RI on pH-metry alone, only 7 (33.3%) infants were diagnosed with GERD. More than 100 GER episodes detected by MII were found in 10 (47.6%) infants. Nineteen percent of infants were diagnosed with GERD based on both pH and MII.ConclusionBoth acid and non-acid reflux seem to play a significant role in the pathogenesis of GER-related BRUE in infants.

Diagnostic Evaluation Low Yield for Patients with a Lower-Risk Brief Resolved Unexplained Event.

In contrast to patients with an apparent life-threatening event (ALTE), the American Academy of Pediatrics recommends very limited evaluation for patients categorized as lower-risk brief resolved unexplained event (BRUE). This retrospective review aims to explore potential missed diagnostic opportunities for patients with a lower-risk BRUE (n = 10) through comparison with a subset of patients with ALTE (n = 72). None of the patients with a lower-risk BRUE had laboratory, imaging or ancillary studies that were diagnostic. Among patients with ALTE, 5 had laboratory and 3 had imaging studies that were diagnostic. None of the patients with a lower-risk BRUE had recurrent events during hospitalization or a serious underlying diagnosis identified within the 90 day follow-up period. As recommended by the AAP, patients with a lower-risk BRUE do not need diagnostic evaluation and can be discharged home with outpatient follow-up.

Clinical Features of Children with Abusive Head Injury and Apparent Life-Threatening Events Upon Presentation to a Children’s Hospital

Background: The symptoms of child abuse and ALTE are similar. Diagnosing child abuse in those who present with an ALTE may be difficult since the symptoms are similar, and bruising is not always seen in those abused. Approximately only 50% of infants who have bruising are found to be abused. There is limited literature showing bruises to the face or blood in the nose or mouth are distinguishing features of those abused infants who initially present to the Emergency Department (ED) for ALTE. Objective: To determine if bruises or contusions to the face or body in infants occur more often in those who present to the ED as an ALTE but found to have Abusive Head Injury (AHI) versus those who present as ALTE and not found to have AHI. A secondary aim was to determine if blood in the mouth and/or nose was present in those with ALTE but found to have AHI. Methods: Retrospective case-control study of infants Results: There were 49 patients in the study: 20 AHI and 29 non-AHI. All infants in both groups had apnea as a presenting symptom. There were no differences in race or gender between groups. No patients in the non-AHI group had retinal hemorrhages. There was not a significant difference in CPR performed prior to arriving to the ED between groups. Intubation was performed with higher frequency in the AHI patients than non-AHI patients (62% vs 0%, p=0.002 by Fisher’s Exact Test). All nine patients requiring intubation were in the AHI group and had intracranial bleeds. Bruises were present with higher frequency in the abused than non-abused group (31% vs 0%, P=0.017 by Fisher’s Exact Test). All bruises were found on patients’ bodies and none on their faces. There were 2 patients with blood from the nose but those were in the non-AHI group and had received CPR. Conclusions: Infants with ALTE who have AHI are more likely to present with bruising to the body, retinal hemorrhages, and intracranial bleeds than infants who have AHI. Blood in the nose does not identify those with AHI. The performance of CPR does not differentiate between groups but the need for intubation was associated with AHI.

Respiratory polygraphy in subjects with bronchopulmonary dysplasia: a retrospective study.

Periodic assessment of the need for oxygen supplementation and/or mechanical ventilation in children with severe bronchopulmonary dysplasia (BPD) is crucial. The aim of the study was to analyze the indications and results of respiratory polygraphies (RP) performed in preterm infants with BPD followed at a tertiary university hospital. All subjects < 5-year-old with BPD who had a RP between September and February 2018 were included. The indications and results of RP and consequent medical management were analyzed. Fourteen infants (9 females, mean gestational age 27.6±3.3 weeks) underwent a RP at mean age of 26.4±19.4 months. Five subjects were evaluated for the need of long-term respiratory support (RS), 3 started continuous positive airway pressure (CPAP), 2 were weaned from RS. Four subjects underwent RP for suspected obstructive sleep apnea (OSA), one started on CPAP. Central apnea syndrome (CSA) was confirmed in 2 subjects and one was started on non-invasive ventilation. RP allowed safe tracheostomy decannulation in 2 subjects. Finally, RP was normal in one patient who had a brief resolved unexplained event (BRUE). RP represents an important tool for the evaluation of children with BPD and leads to important therapeutic decisions.

Brief resolved unexplained event: how life-threatening are they? (literature review)

This article presents the view expressed in contemporary scientific literature on the evolution of definitions, diagnostic approaches and risk stratification for suddenly occurred life-threatening conditions accompanied by cardiorespiratory disorders in children of the first year of life. The term “brief resolved unexplained event (BRUE)” has replaced the terms “apparent life-threatening event” and “aborted sudden infant death syndrome”. The provided information is derived from clinical guidelines of the American Academy of Pediatrics and the Italian Society of Pediatrics dealing with the above clinical conditions. The authors’ view is focused on the life-threatening situations and risk stratification for adverse outcome. The criteria for classifying infants’ condition as a low risk of life-threatening condition following the occurred event are provided. The authors’ collective invites the national pediatric community for a discussion on the issue of a life-threatening nature of BRUE among children of the first year of life in order to build a strategic action plan dealing with the necessity of hospitalization and scope of diagnostic insight into the cause of the event.

COVID-19 in Children and the Dynamics of Infection in Families.

Since the onset of coronavirus disease (COVID-19) pandemic, children have been less affected than adults in terms of severity1–3 and frequency, accounting for <2% of the cases.2–5 Unlike with other viral respiratory infections, children do not seem to be a major vector of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission, with most pediatric cases described inside familial clusters6 and no documentation of child-to-child or child-to-adult transmission.7,8 The aim of this work was to describe the clinical presentation of the first 40 pediatric cases of COVID-19 in our city and the dynamics of their familial clusters.From March 10 to April 10, 2020, all patients <16 years old with SARS-CoV-2 infection were identified by means of the Geneva University Hospital’s surveillance network (Switzerland). The network notifies the institution’s pediatric infectious diseases specialists about results of nasopharyngeal specimens tested for SARS-CoV-2 by reverse-transcription polymerase chain reaction. This study was approved by the Regional Ethics Committee. After informed oral parental consent and its documentation in the medical charts, chart reviews were used to retrieve clinical data, and parents were called for patients and household contacts (HHCs) follow-up. HHCs were considered suspect if they had fever or acute respiratory symptoms, as per the Swiss Federal Office for Public Health’s case definition9 (Supplemental Information).Categorical data were compared using the χ2 test, with P values <.05 considered significant. Statistics were performed using SPSS version 23.0 (IBM SPSS Statistics, IBM Corporation).Among a total of 4310 patients with SARS-CoV-2, 40 were <16 years old (0.9%). One patient for which telephone follow-up was not possible was excluded because of the inability to evaluate clinical evolution and HHC symptoms. The median follow-up of the households was 18 days (interquartile range [IQR]: 14–28).Demographics, clinical presentation, and diagnosis of the study children are detailed in Table 1. Of note, 29 (74%) patients were previously healthy; the most frequently reported comorbidities were asthma (10%), diabetes (8%), obesity (5%), premature birth (5%), and hypertension (3%). Seven patients (18%) were hospitalized to the ward, for a median duration of 3 days (IQR: 2–4); reasons for admission were surveillance for nonhypoxemic viral pneumonia (n = 2), fever without source (n = 2), apparent life-threatening event (n = 1), and sepsis-like event (n = 1); 1 paucisymptomatic child admitted because both parents had severe COVID-19 (n = 1). No patient required ICU admission or SARS-CoV-2–specific therapies. The others 32 patients were managed as outpatients. All patients had a complete resolution of symptoms by day 7 after diagnosis.Familial cluster evaluation revealed a t number of 4 household members per family (IQR: 3–4). Among the 111 HHCs of study children, mothers predominated (n = 39), followed by fathers (n = 32), pediatric siblings (n = 23), adult siblings (n = 8), and grandparents (n = 7) (Fig 1). Adult HHCs were suspected or confirmed with COVID-19 before the study child in 79% (31/39) of cases. In only 8% (3/39) of households did the study child develop symptoms before any other HHC (Fig 1). Interestingly, 85% (75/88) of adult HHCs developed symptoms at some point, compared with 43% (10/23) of pediatric HHCs (P < .001). Also, 92% (36/39) of mothers developed symptoms, compared with 75% (24/32) of fathers (P = .04).Most children in our study had mild or atypical presentations: headache and nasal discharge were described in more than half of cases, and anosmia and abdominal symptoms were described in <20%, which is more frequent than previously described.2 Some of these symptoms might be underreported because younger children may not be able to describe them.In 79% of households, ≥1 adult family member was suspected or confirmed for COVID-19 before symptom onset in the study child, confirming that children are infected mainly inside familial clusters.6 Surprisingly, in 33% of households, symptomatic HHCs tested negative despite belonging to a familial cluster with confirmed SARS-CoV-2 cases, suggesting an underreporting of cases. In only 8% of households did a child develop symptoms before any other HHC, which is in line with previous data in which it is shown that children are index cases in <10% of SARS-CoV-2 familial clusters10; however, with our study design, we cannot confirm that child-to-adult transmission occurred.This study has some limitations. The study sample likely does not represent the total number of pediatric SARS-CoV-2 cases during this time period. Indeed, patients with milder or atypical presentation might not have sought medical attention. Moreover, the recall of symptom onset among HHCs might be inaccurate, although this seems for once less likely because of the confinement measures and anxiety in the community.The results of this study are important because of the extensive HHC tracing and the almost absence of loss to follow-up. Extended diagnostic screening of suspected cases and thorough contact tracing are needed to better understand the dynamics of transmission within households.

Patients with Apparent Life-Threatening Events meeting criteria for Brief Resolved Unexplained Events: a secondary analysis from a prospective registry

Purpose: In 2016, the Subcommittee on Apparent Life-Threatening Events (ALTE) of the American Academy of Pediatrics (AAP) published a clinical practice guideline renaming ALTE as Brief Resolved Unexplained Events (BRUE). The purpose of this study is to identify the proportion of patients previously diagnosed with apparent life-threatening events (ALTE) who would meet criteria for brief resolved unexplained events (BRUE) and to identify rates of significant outcomes in the following subgroups: ALTE not meeting criteria for BRUE, low-risk BRUE, and non-low-risk BRUE. Methods: We performed a secondary analysis of a single-center prospective registry of …

Patients with Apparent Life-Threatening Events meeting criteria for Brief Resolved Unexplained Events: a secondary analysis from a prospective registry

Patients with Apparent Life-Threatening Events meeting criteria for Brief Resolved Unexplained Events: a secondary analysis from a prospective registry

Application of a new terminology "BRUE: Brief, resolved and unexplained events". Definitions and recommendations

Three decades ago, the term Apparent Life-Threatening Events (ALTE) was proposed and was gra dually incorporated into the clinical approach of these patients, allowing to determine risks, attribute causes, and perform specific treatments. However, this led to studies and hospitalizations considered unnecessary in many cases, increasing health costs. For this reason, the concept of Brief Resolved Unexplained Events (BRUE) was created, in order to reduce the subjectivity of the event and focus a management strategy according to the risk determination. This article analyzes the differences bet ween ALTE and BRUE according to international and Chilean consensus, deepening the approach and incorporating relevant considerations for the daily clinical practice with infants who present a BRUE.