• Brief Resolved Unexplained Event

    (BRUE; Previously know as ALTE)

    Definition

    A brief resolved unexplained event (BRUE) is a set of symptoms in an infant that cause the caregiver to believe the child may be in distress or danger. BRUE lasts less than one minute and includes one or more of the following:
    • Changes in skin color—pale or blue skin
    • Breathing that may be stopped, slower, or irregular
    • Noticeable changes in responsiveness
    • Noticeable changes in muscle tone
    Infant Airway and Lungs
    IMAGE
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    Causes

    The cause of BRUE is not known.

    Risk Factors

    BRUE affects infants under one year of age. There are no risk factors because the cause is unknown.

    Symptoms

    BRUE is one or more of following:
    • Changes in skin color—pale or blue skin
    • Breathing that may be stopped, slower, or irregular
    • Noticeable changes in responsiveness
    • Noticeable changes in muscle tone
    Infants with BRUE return to their normal health in less than one minute.
    More serious symptoms require immediate medical attention. Examples include:
    • Breathing that stops
    • Choking or gagging
    • Bleeding from the nose or mouth

    Diagnosis

    You will be asked about your baby’s symptoms and medical history, including what you noticed in the time leading up to the event. A physical and neurological exam will be done. Your baby may have an ECG to check the electrical activity of the heart.
    A diagnosis of low-risk BRUE is confirmed if the event lasted less than one minute, your baby returned to normal health, and no cause can be identified.
    High-risk BRUE is diagnosed if the other criteria are not met or your baby has had a similar event in the past. At this point, the doctor will look for an underlying cause. Tests may include:
    • Blood tests or cultures
    • Urine tests or cultures
    • Imaging tests such as x-rays or scans
    • EEG—to check the electrical activity of the brain
    Testing will depend on the suspected cause. Your baby may be referred to a specialist for further evaluation.

    Treatment

    BRUE does not require treatment. After your baby is observed and evaluated, they will be able to go home. BRUE can cause distress and anxiety for a parent, but no further monitoring beyond what is normal is needed.
    Taking classes in cardiopulmonary resuscitation (CPR) and first aid can help you be prepared in case of an emergency.

    Prevention

    There are no current guidelines to prevent BRUE because the cause is not known.

    RESOURCES

    Family Doctor—American Academy of Family Physicians https://familydoctor.org

    Healthy Children—American Academy of Pediatricians https://www.healthychildren.org

    CANADIAN RESOURCES

    Caring for Kids—Canadian Paediatric Society http://www.caringforkids.cps.ca

    Health Canada https://www.canada.ca

    References

    ALTE and BRUE. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/pediatrics/miscellaneous-disorders-in-infants-and-children/alte-and-brue. Updated February 2017. Accessed September 18, 2017.

    Brief resolved unexplained event (BRUE). EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T909988/Brief-resolved-unexplained-event-BRUE. Updated July 19, 2016. Accessed September 18, 2017.

    Tieder JS, Bonkowsky JL, Etzel RA, et al. Brief resolved unexplained events (formerly apparent life-threatening events) and evaluation of lower-risk infants. Pediatrics. 2016;137(5)e20160590.

    Revision Information

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