Context and Definition

Infants who present with an acute event reported by the caregiver represent a wide range of patients with diverse pathophysiology.

The challenge as physicians is to identify those who are at risk of recurrence or of having a serious underlying disorder.

The term “BRUE” (Brief Resolved Unexplained Event) has replaced the term “ALTE” (Apparent Life-Threatening Event).

ALTE is an old term for events that are characterised by some combination of “apnoea, colour change, change in muscle tone, or choking and gagging and are frightening to the observer”.

This term has been replaced as it described events that ranged from normal physiological events to pathological events and so was not useful in determining diagnosis, treatment or prognosis.

In the majority of patients, ALTEs were often benign, but the name implied that the child’s life was at risk. This reinforced parental anxiety and potentially led to unnecessary investigations.

BRUE is defined as an episode in an infant less than 12 months of age characterised by:

  • <1 minute duration (typically 20-30s)
  • A return to baseline state
  • Not explained by any identifiable medical condition (i.e. medically well)
  • Includes one or more of the following features:
    • Central cyanosis/pallor
    • Absent, decreased or irregular breathing
    • Marked change in tone (hyper- or hypotonia)
    • Altered level of consciousness

Where events do not fit the definition of BRUE, an alternative diagnosis should be sought.

Learning Bite:

By definition, the event has to have had a clear beginning and end, so has “resolved” before presentation to hospital.

Learning Bite:

BRUE is a description of an event; not a disease entity in, and of, itself. 

Post a comment

Leave a Comment