ED Pathway for Evaluation of Infants with a BRUE
Infant (< 1 year old) with a Brief, Resolved, Unexplained Event
(BRUE)
Does Not Meet BRUE Criteria
  • Patient has additional symptoms
  • Abnormal vital signs
  • Explanation for event
    identified
  • Event criteria are absent
Meets BRUE Criteria
Sudden, brief, and now resolved episode of one or more of the following in an infant < 1 year age:
  • Cyanosis or pallor
  • Absent, decreased or irregular breathing
  • Marked change in tone (hyper- or hypotonia)
  • Altered responsiveness
  • No explanation for the event after full history and exam
  • Age > 60 days
  • Gestational age
    • Born ≥ 32 weeks' gestation
    • and post-conception age ≥​ 45 weeks
  • No CPR by trained medical provider
  • Event lasted < 1 minute
  • First event
  • No concerning history
  • Baseline exam for infant
  • Any of the lower-risk criteria not met
  • Concerns identified from H&P
  • For example:
    • Family history of sudden death
    • Family history of infant death
    • Concerning social history
Management Recommendations
Management Recommendations
Evaluation and disposition as clinically indicated
  • Review the nature of event
    with caregivers
  • Reassurance; shared decision-making
  • Observe infant in ED for 1-2 hrs on
    continuous pulse ox, PO trial
  • Consider pertussis screen, ECG as clinically indicated
  • Routine laboratory testing is generally not needed
Discharge
BRUE PFE (13:B:75)
  • Review BRUE discharge Instructions with family
  • Follow-up with PMD next day or as soon
    as possible
Posted: March 2017
Reviewed: March 2019
Authors: M. Mittal, MD; I. Peterside, MD; E. Kane, MD; J. Lavelle, MD; L. Ravener, MD; E. Hardy, CRNP; G. Sharer, RN