Brief resolved unexplained event - BRUE (< 12 months)
Not a BRUE, workup and manage appropriately
Inclusion Criteria
- Patient well-appearing, normal vital signs
- Unexpected, brief episode which was frightening to a caretaker and now resolved
Exclusion Criteria
- Immunosuppressed, cancer
- Complex medical or surgical history
- Toxic appearance
- Abnormal vital signs, +symptoms, clinical findings on exam, (cough, fever, respiratory difficulties)
Treat appropriately, consider pediatric consultation
H&P suggests that event was life threatening OR has high risk features?
Are ALL of the following true?
- Age > 60 days
- ≥ 32 weeks gestational age and corrected gestational age ≥ 45 weeks
- No CPR by trained medical provider
- Event lasted < 1 min
- First event
- Admit for 24 hours obs
- Continuous CR, pulse oximetry
- Re-evaluate for development of new symptoms, changes in exam to identify underlying cause
- Educate caregivers about BRUEs, offer CPR training resources
The observer reports a sudden, brief, and now resolved episode 1 or more of the following:
- Cyanosis or pallor
- Absent, decreased, or irregular breathing
- Marked change in tone (hyper- or hypotonia)
- Altered level of responsiveness
- AND there is no explanation for a qualifying event
Consider other diagnosis
Detailed history of episode and potential underlying risk factors (including Social and Family history)
LOWER RISK Patient
- Discharge with PMD follow up within 24 hours
Complete physical exam
High risk features
- Prematurity (Born at <32 weeks GA AND <45 weeks postconceptal age)
- Previous BRUE (especially within the past 24 hours)
- BRUE caused significant physiologic compromise
- Loss of consciousness
- Persistent cyanosis
- Significant resuscitation by caretaker (not just stimulation)
- Toxic appearance or ongoing symptoms (lethargy, vomiting, poor feeding / urine output or respiratory distress)
- Suspicion for abuse / signs of trauma
- Unexplained death of sibling
- Dysmophic features or other signs of congenital disease
Low risk features
- First episode
- Short duration (< 1 minute)
- Self-correcting
- Associated with feeding
- No physiologic compromise
- History suggests a benign cause
- Consistent with normal variation in breathing (periodic breathing / respiratory pauses)
Discharge Criteria
- No further events
- Reassuring exam and vital signs
HIGHER RISK Patient
- Consider neuroimaging if concern for intracraninal pathology or NAT.
Complete Blood Count, Serum
Complete Metabolic Panel, Serum
Urinalysis with micro, Urine
Urine Culture, Urine
Alcohol Volatile Screen, Serum
Urine Toxicology, Urine
X-ray Chest, 1 view
Respiratory Viral Panel, Nasopharyngeal
Pertussis PCR, Nasopharyngeal
ECG
