BRUE (Brief Resolved Unexplained Event) from AAP 2016, replacing ALTE (apparent life threatening event).  “Life threatening” is unnecessarily anxiety provoking – and subjective for parents. 

Guidance for “low risk”:

• >60 days of age
• >=32/40 gestation or CGA>=45 weeks
• No CPR by trained practitioner
• <1min duration
• First event
• No concerning features on history/examination

If low risk criteria fulfilled, no investigations are required – consider gas and urinalysis if clinical concern.

Otherwise depends on history and examination. Consider:

• Bloods including glucose, gas
• NPA for bugs
• ECG

Management could then be a period of observation, or discharge home with safety netting.

A US study looking at this guidance found that a serious diagnosis was made in 4.0% of cases; about half the time, the diagnosis was made at the time, but the rest of the time only afterwards.

The most common serious diagnoses were seizures and airway abnormalities.

The chances of finding a serious diagnosis was higher where there was a history of a similar event (obviously), an event duration >1 minute, an “abnormal” medical history (previous hospitalisation, underlying medical problem), and altered responsiveness as a feature of the event. [Peds 2021]

But I’m disappointed there is no mention in the RHC guidance about SIDS prevention advice.