| Higher-risk Criteria |
- Age ≤ 60 days
- Gestational age
- Born < 32 wks gestation or corrected gestational age < 45 wks
- CPR by trained medical provider
- Event lasted > 1 min
- Recurring events
- Abnormal (different from baseline) exam for infant
- Concerning history: e.g., family history of sudden death, or infant death, concerning social, feeding, or respiratory-related history
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| Considerations for Management |
- Rationale
In recent multi-center studies, > 80% of all cases of BRUE met higher risk criteria. Serious underlying diagnoses and recurrent events remain unusual among higher-risk cohorts as well.
- Initial Evaluation
Aims to detect diagnoses that need immediate treatment or intervention to prevent repeat events.
- Secondary Evaluation
Includes additional recommendations to determine causes for repeat events.
- Initial evaluation may include:
Continuous pulse ox and cardiac monitor
- Social work screening if any concern for safety or family support
- Feeding evaluation if event related to feeding
- Diagnostic testing, as indicated
- Electrocardiogram
- Rapid viral respiratory panel or appropriate viral testing
- Pertussis test in under-immunized and/or exposed patient
- Complete blood count, basic metabolic panel, blood glucose, venous blood gas, lactic acid
- Secondary evaluation if no other diagnosis made:
Further testing during hospitalization or in outpatient setting as appropriate
- Testing may include:
- Continuous prolonged pulse ox and cardiac monitor
- Observation for repeat events
- Clinical swallow evaluation and feeding consultation
- Other interventions to consider
- Videofluoroscopic swallow study
- Subspecialty consultation
- Gastrointestinal, Otolaryngology, Pulmonary, Neurology, Cardiology, Biochemical Genetics/Metabolism
- Comprehensive polysomnography
- CT or MRI of head
- Extended electroencephalogram
- Ammonia, CHOP urine drug screen, Hospital of the University of Pennsylvania urine Drug Analysis and Pain Management Panel, and/or serum ethanol
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