Badness BRUEing?


    Badness BRUEing?

    For the very few things they actually do, babies can be very complicated. Breathing irregularities especially can pose a challenge to providers. Knowing the difference between a benign and a dangerous cause for apnea/cyanosis/loss of muscle tone or choking is difficult and underlies the diagnosis of BRUE.

    BRUE (brief, resolved, unexplained event) usually occurs in the first 2 months of life and is defined as a combination of apnea, color change, loss of muscle tone, choking or gagging. Risk of subsequent death is 0%-6% driven in large part by those BRUE cases requiring CPR.

    Underlying causes (

    • Unknown (41%)
    • GERD/Choking/Laryngospasm (31%)
    • Seizure (11%)
    • URI/Respiratory infection (8%)
    • ENT infections (3.6%)
    • Other (5%)
    • Non-accidental trauma (1%)

    Workup: if the child appears and well in your care and symptoms are not reoccurring, how do you determine if this is a dangerous or benign event?

    • Detailed history including surrounding events, recent illness, sleeping/eating habits, family history, possible exposures and tobacco/alcohol/drugs in the house
    • Watch the child in the ED for reoccurrence
      • Remember that healthy newborns can have non-pathologic respiratory pauses up to 30s and runs of bradycardia for up to 10s during sleep (tricky babies)
      • Labs are typically not useful if the child appears well in your care

    Disposition: Traditionally BRUE cases are admitted for observation. attempted to develop a decision rule for discharging a patient home. Those who can be safely discharged are:

    • Premature with URI sx
    • Full-term with non-cyanotic color change
    • Full-term with cyanotic color change and a history of choking during the episode

    This method will drastically decrease admission rates, but misses 3.8% of patients with serious events. Thus clinical gestalt is still important when considering a child with an unexplained apnea event.

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