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Brief Resolved Unexplained Event

(BRUE; Previously known as ALTE)

Definition

A brief resolved unexplained event (BRUE) is a set of symptoms in an baby that have no known cause. It is when one or more of these problems last for less than one minute:

  • Skin that is very pale or blue
  • Breathing that may be stopped, slower, or not regular
  • Changes in responsiveness
  • Muscles that seem stiff or floppy

Causes

The cause of BRUE is not known.

Risk Factors

BRUE happens to babies under one year of age. There are no risk factors because the cause is not known.

Symptoms

BRUE is when one or more of these problems last for less than one minute:

  • Skin that is very pale or blue
  • Breathing that may be stopped, slower, or not regular
  • Changes in responsiveness
  • Muscles that seem stiff or floppy

Diagnosis

You will be asked about your baby’s symptoms and recent health history. You will be asked what happened before, during, and after the event. A physical exam will be done. BRUE is diagnosed if symptoms lasted less than one minute, the baby returns to normal health, and no other cause is found.

Tests may be done to rule out other possible causes, such as infection. These may be:

  • Blood or urine tests to look for signs of infections, such as pertussis
  • ECG to look for heart problems
  • Imaging tests to look for signs of trauma or heart or lung problems
  • EEG to look for problems with the brain

Treatment

BRUE does not need to be treated. The doctor may want to see the baby again to do another exam.

The baby is not more likely to need it, but it is important for caregivers to be trained in cardiopulmonary resuscitation (CPR) and first aid.

Prevention

There are no current guidelines to prevent BRUE. The cause is not known.

RESOURCES:

Family Doctor—American Academy of Family Physicians
https://familydoctor.org

Healthy Children—American Academy of Pediatricians
https://www.healthychildren.org

CANADIAN RESOURCES:

Caring for Kids—Canadian Paediatric Society
https://www.caringforkids.cps.ca

Health Canada
https://www.canada.ca

REFERENCES:

ALTE and BRUE. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/pediatrics/miscellaneous-disorders-in-infants-and-children/alte-and-brue. Updated February 2017. Accessed December 21, 2017.

Brief resolved unexplained event (BRUE). EBSCO DynaMed website. Available at:https://www.dynamed.com/condition/brief-resolved-unexplained-event-brue-22. Accessed August 27, 2020.

Tieder JS, Bonkowsky JL, et al. Brief resolved unexplained events (formerly apparent life-threatening events) and evaluation of lower-risk infants. Pediatrics. 2016;137(5)e20160590.

Last reviewed November 2018 by EBSCO Medical Review Board Kari Kassir, MD  Last Updated: 9/3/2020