Last updated March 14, 2022

Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants

Key Action Statements

When managing an infant aged >60 d and <1 y and who, on the basis of a thorough history and physical examination, meets criteria for having experienced a lower-risk BRUE, clinicians:

Cardiopulmonary evaluation

Need not admit infants to the hospital solely for cardiorespiratory monitoring. (BWeak)
328602
May briefly monitor patients with continuous pulse oximetry and serial observations. (DWeak)
328602
Should not obtain a chest radiograph. (BModerate)
328602
Should not obtain a measurement of venous or arterial blood gas. (BModerate)
328602
Should not obtain an overnight polysomnograph. (BModerate)
328602
May obtain a 12-lead electrocardiogram. (CWeak)
328602
Should not obtain an echocardiogram. (CModerate)
328602
Should not initiate home cardiorespiratory monitoring. (BModerate)
328602

Child abuse evaluation

Need not obtain neuroimaging (CT, MRI, or ultrasonography) to detect child abuse. (CWeak)
328602
B. Should obtain an assessment of social risk factors to detect child abuse. (CModerate)
328602

Neurologic evaluation

Should not obtain neuroimaging (CT, MRI, or ultrasonography) to detect neurologic disorders. (CModerate)
328602
Should not obtain an EEG to detect neurologic disorders. (CModerate)
328602
Should not prescribe antiepileptic medications for potential neurologic disorders. (CModerate)
328602

Infectious disease evaluation

Should not obtain a WBC count, blood culture, or cerebrospinal fl uid analysis or culture to detect an occult bacterial infection. (B, Strong)
328602
Need not obtain a urinalysis (bag or catheter). (CWeak)
328602
Should not obtain chest radiograph to assess for pulmonary infection. (BModerate)
328602
Need not obtain respiratory viral testing if rapid testing is available. (CWeak)
328602
May obtain testing for pertussis. (BWeak)
328602

Gastrointestinal evaluation

Should not obtain investigations for GER (eg, upper gastrointestinal tract series, pH probe, endoscopy, barium contrast study, nuclear scintigraphy, and ultrasonography). (CModerate)
328602
Should not prescribe acid suppression therapy. (CModerate)
328602

IEM evaluation

Need not obtain measurement of serum lactic acid or serum bicarbonate. (CWeak)
328602
Should not obtain a measurement of serum sodium, potassium, chloride, blood urea nitrogen, creatinine, calcium, or ammonia. (CModerate)
328602
Should not obtain a measurement of venous or arterial blood gases. (CModerate)
328602
Need not obtain a measurement of blood glucose. (CWeak)
328602
Should not obtain a measurement of urine organic acids, plasma amino acids, or plasma acylcarnitines. (CModerate)
328602

Anemia evaluation

Should not obtain laboratory evaluation for anemia. (CModerate)
328602

Patient- and family-centered care

Should offer resources for CPR training to caregiver. (CModerate)
328602
Should educate caregivers about BRUEs. (CModerate)
328602
Should use shared decision-making. (CModerate)
328602

Recommendation Grading

Overview

Title

Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants

Authoring Organization

Publication Month/Year

May 1, 2016

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Child, Infant

Health Care Settings

Ambulatory, Emergency care, Home health, Hospital, Outpatient

Scope

Assessment and screening, Diagnosis, Management, Treatment

Diseases/Conditions (MeSH)

D020181 - Sleep Apnea, Obstructive, D004827 - Epilepsy, D008659 - Metabolic Diseases, D002649 - Child Abuse, D000013 - Congenital Abnormalities, D016489 - Head Injuries, Closed, D008661 - Metabolism, Inborn Errors

Keywords

ALTE, BRUE, Appearant life-threatenting event, brief resolved unexplained event, family-centered approach, SIDS, Sudden Infant Death Syndrome, GER, gastroesophogeal reflux

Source Citation

Joel S. Tieder, et al. Brief Resolved Unexplained Events (Formerly Apparently Life-Threatening Events) and Evaluation of Lower-Risk Infants. Pediatrics. 2016; 137 (5): e20160590.