Carl R. Darnall Army Medical Center - Health Library

Brief Resolved Unexplained Event

(BRUE; Previously know as ALTE)

Definition

A brief resolved unexplained event (BRUE) is a set of symptoms in an infant that cause the caregiver to believe the child may be in distress or danger. BRUE lasts less than 1 minute and includes one or more of the following:

  • Changes in skin color—pale or blue skin
  • Breathing that may be stopped, slower, or irregular
  • Noticeable changes in responsiveness
  • Noticeable changes in muscle tone

Infant Airway and Lungs

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Causes ^

The cause of BRUE is not known.

Risk Factors ^

BRUE affects infants under 1 year of age. There are no risk factors because the cause is unknown.

Symptoms ^

BRUE is one or more of following:

  • Changes in skin color—pale or blue skin
  • Breathing that may be stopped, slower, or irregular
  • Noticeable changes in responsiveness
  • Noticeable changes in muscle tone

Infants with BRUE return to their normal health in less than 1 minute.

More serious symptoms require immediate medical attention. Examples include:

  • Breathing that stops
  • Choking or gagging
  • Bleeding from the nose or mouth

Diagnosis ^

You will be asked about your baby’s symptoms and medical history, including what you noticed in the time leading up to the event. A physical and neurological exam will be done. Your baby may have an ECG to check the electrical activity of the heart.

A diagnosis of low-risk BRUE is confirmed if the event lasted less than one minute, your baby returned to normal health, and no cause can be identified.

High-risk BRUE is diagnosed if the other criteria are not met or your baby has had a similar event in the past. At this point, the doctor will look for an underlying cause. Tests may include:

  • Blood tests or cultures
  • Urine tests or cultures
  • Imaging tests such as x-rays or scans
  • EEG—to check the electrical activity of the brain

Testing will depend on the suspected cause. Your baby may be referred to a specialist for further evaluation.

Treatment ^

BRUE does not require treatment. After your baby is observed and evaluated, they will be able to go home. BRUE can cause distress and anxiety for a parent, but no further monitoring beyond what is normal is needed.

Taking classes in cardiopulmonary resuscitation (CPR) and first aid can help you be prepared in case of an emergency.

Prevention ^

There are no current guidelines to prevent BRUE because 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
http://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 Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T909988/Brief-resolved-unexplained-event-BRUE. Updated October 9, 2017. Accessed December 21, 2017.

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

Last reviewed December 2017 by EBSCO Medical Review Board Kari Kassir, MD  Last Updated: 9/18/2017