I was doing my monthly pediatric review material and came across BRUE. I looked at it and said what the heck are they talking about. Then I realized that they had taken a condition that I had seen many times over the years and given it a different name.
BRUE stands for brief unexplained resolved event. As the name suggests it refers to something short lasting. It is no longer happening. It is something that has no explanation. And it is a one time event.
Of course what’s in a name? Until they changed it, we used to give it an entirely different name. It was called an apparently life-threatening event (ALTE). ALTE referred to both BRUE as well as more serious causes of symptoms. They decided to separate them.
BRUE’s occur in children under one year of age. These episodes occur in about one out of every 250 infants. They account for just under one percent of emergency room visits for this age. They have several characteristics. Each infant tends to have different ones of those characteristics.
One characteristic is color change. They may become pale. They may turn blue. Infants commonly have bluish hands and feet when cold. The BRUE blueness is more likely to be on the face or chest or gums. A second characteristic is a change to the breathing pattern. Breathing might be slow. It might be irregular. It might be absent. A third characteristic is a change in muscle tone. The infant might stiffen up. The infant may lose muscle tone. A fourth characteristic is a change in responsiveness. They might not be able to be awakened. They may go from alert to sleep. They may have lethargic movements.
The problem is that a true BRUE is not harmful. However, you have to make that determination. What you cannot do is say to the parents: “Ah, it’s just BRUE. Take your infant home and don’t worry about it.” Think about the response you would get from the parent.
As with any medical condition, history is important. There needs to be a complete description of the event itself. A medical history of both this event and the rest of the infant’s history since birth is essential. Feeding history is also important. Physical exam is important.
If something is found it becomes a BREE (brief resolved explainable event). Treatment would then address that.
Any testing needs to be specific based on the history. Just doing every test imaginable will often lead to wild goose chases for things that are not related.
Testing might be neurological. It might be cardiac. It might be pulmonary. It might be gastrointestinal. It might be infectious. It might be metabolic. It might to look for anemia. It might require considering child maltreatment.
Parents need a lot of reassurance before taking the infant home. That can sometimes be done with a monitoring period of several hours in the emergency room.
The idea of hospitalization for further monitoring really depends on the parents’ level of comfort. Only five percent of these infants ever go on to having an actual significant cause found. In 40 percent of those cases, it tends to be something that is not serious. The most common cause is just reflux of food. The airway shuts down for protection with temporary stoppage of breathing.
No matter what the decision, it is important to ensure that the parents learn CPR in case there is another instance.
If someone ever has an infant with unexplained symptoms and they are told the diagnosis is BRUE, it does not have anything to do with coffee.