The American Academy of Pediatrics has recently released new guidelines attempting to replace the term apparent-life threatening event (ALTE) with brief resolved unexplained event (BRUE). The term ALTE was somewhat subjectively defined and represented an event scary to an observer usually involving apparent apnea of an infant. BRUE is defined as an event occurring in an infant < 1year of age seen to have a brief, and now resolved episode of at least one of the following:
1) cyanosis or pallor
2) absent, decreased, or irregu lar breathing
3) marked change in tone (hyper-, hypotonia
4) altered level of responsiveness
In addition, there should be no explanation for said event based on history and physical. These new guidelines have also identified features associated with BRUE that can enable clinicians to risk stratify their patients into lower and higher risk groups. These key features are:
1) age > 60 days
2) born at least 32 wks gestation (45 wks corrected)
3) no CPR by trained medical provider
4) event lasted < 1 min
5) first event
In patients without a concerning H&P, and that meet the above low risk criteria exhaustive work-ups are likely unnecessary. Admission for purely cardio-respiratory monitoring is also not recommended. Pertussis testing, obtaining a 12 lead ECG, and CPR training are recommended. How to manage pt's that don't meet low risk criteria is less clear.
References:
1) Tieder, Joel S. & Bonkowsky, Joshua L et. at. "Brief Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants" Pediatrics. May 2016, Volume 137, Issue 5
