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

“Brief” is by definition less than 1 minute, but typically 20-30 seconds. Only intended for babies under 1yr.

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.

AAP advises against home cardiorespiratory monitoring given costs and false alarms vs uncertain benefit.

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.