Title:Update on the Evaluation and Management of Brief Resolved Unexplained Events (Previously Apparent Life-Threatening Events)
Volume: 12
Issue: 4
Author(s): Eric Zwemer*, Ilene Claudius and Joel Tieder
Affiliation:
- Division of Pediatrics and Adolescent Medicine, University of North Carolina 231 MacNider, CB#7225 Chapel Hill, NC 27599,United States
Keywords:
Apparent life-threatening event, brief resolved unexplained event, child abuse, etiology, risk stratification, sudden
infant death syndrome.
Abstract: Background: The thirty-year-old term “apparent life-threatening event” (ALTE) is difficult
to apply in clinical practice and research. The American Academy of Pediatrics now defines these
events as brief resolved unexplained events (BRUEs), stratifies infants based on the risk of recurrence
or of a serious underlying condition, and offers evidence-based management recommendations for infants
at lower-risk.
Objective: To review recent ALTE literature as it relates to BRUEs.
Method: Articles were identified by searching several clinical databases. English-language articles
from January 2006 to August 2016 that address ALTEs or BRUEs were included.
Results: Significant variation exists in the evaluation and management of patients diagnosed with
BRUE. Research demonstrates low utility of most diagnostic testing, including prolonged cardiorespiratory
monitoring, in the well-appearing infant without an obvious etiology. Risk factors for recurrent
adverse events or significant underlying pathology include young age, prematurity, and presence of
multiple events. There is little evidence to provide guidance for the management of higher-risk infants.
Conclusion: BRUE is a diagnosis of exclusion to be applied when there is no apparent etiology after
performing an appropriate history and physical examination. Lower-risk infants should not undergo
routine diagnostic testing and should not be admitted solely for cardiorespiratory monitoring. Higherrisk
infants are more likely to benefit from diagnostic testing and admission; however, routine screening
testing is unnecessary, and the history and physical should guide the clinician’s approach. Prospective
research is needed to understand the incidence of BRUEs, outcomes in lower and higher-risk infants,
and the utility of diagnostic testing in higher-risk infants.
