Brief Resolved Unexplained Event - An Overview

Introduction:

Every newborn brings joy to the parents. However, taking complete care of them during their development is challenging. Even after such consideration, emergencies may bring about fear in parents. Likewise, sudden changes in breathing, muscle tone, and color of the baby may terrify the caregiver, and it is referred to as a brief resolved unexplained event (BRUE). This article brings forward the characteristic features, risk factors, diagnosis, and management of BRUE.

What Is a Brief Resolved Unexplained Event?

The brief unexplained event refers to temporary changes that occur in babies less than one year of age, and such modifications are severe that frighten the caregivers. For example, the infants may appear pale and have irregular breathing and altered response. However, it lasts for a short duration, and the infant recovers completely; hence it is not life-threatening.

Is Apparent Life-Threatening Events and BRUE the Same?

The apparent life-threatening event (ALTE) is a collection of the following signs:

• Color change.

• Change in muscle tone.

• Irregular breathing.

• Choking.

These changes may occur due to underlying systemic disorders or unknown causes. In 2016, the American academy of pediatrics (AAP) proposed that ALTE be replaced with BRUE, which is temporary, idiopathic (unknown cause), and not life-threatening,

What Causes a Brief Resolved Unexplained Event?

The cause for BRUE is unexplained, and the previously named apparent life-threatening event may occur due to the following reasons:

• Gastroesophageal reflux.

• Child abuse.

• Congenital disabilities.

• Seizure.

• Infections.

• Genetic disorders.

What Are the Risk Factors of BRUE?

Below-listed is the factors that increase the risk of BRUE:

• Age below two months.

• Premature birth - Less than 32 weeks of gestation.

• Previous history of the brief resolved unexplained event.

Infants with the following criteria may have a low risk for BRUE:

• Gestational age is more than 32 weeks.

• Age above 60 days.

• No previous BRUE.

• The BRUE may last for less than 60 seconds in low-risk infants and does not require emergency treatment.

Is a Brief Resolved Unexplained Event Common?

There are no reports to support the prevalence of BRUE. However, a study shows that about 4.1 in 1,000 newborns have had BRUE in Italy.

What Are the Signs and Symptoms?

The parent or the caregiver may get shocked due to the occurrence of the following signs:

• Decreased or no breathing.

• Change in muscle tone; the muscle becomes rigid.

• Change in skin or lip color; it either turns blue or pale.

• Less or unresponsive.

• These signs occur suddenly and last for less than a minute (mostly 20 to 30 seconds).

How Does the Doctor Evaluate BRUE?

The physical examination and history of the infant play a significant role in diagnosing BRUE.

During the physical examination, the doctor may enquire about:

1) The Incidents Before BRUE -

• Was the baby awake or asleep?

• Where did it happen?

• Position of the infant (supine or prone).

• The activity of the infant (feeding or any history of vomiting).

• Previous illness.

2) During the Event - The doctor may ask the parent or caretaker to describe the event, which includes:

• Was the infant quiet or active?

• Breathing or struggling to breathe.

• Normal or pale or cyanotic (blue) color.

• Rigid muscle tone.

• Choking or gagging.

3) End of the Event - The healthcare specialist may note down the instances that happened after the event to diagnose the condition:

• Duration of the event.

• Resolved on its own or required mouth and mouth or chest compression.

• The infant rapidly or gradually resolved.

Other information that the doctor needs to know to evaluate the condition includes:

• Past medications.

• Any underlying systemic problems.

• Any complications during pregnancy.

• Developmental delays.

• Family history.

The essential criteria to be checked during the physical examination include:

• Abnormal heart sounds.

• Low oxygen level.

• Signs of infection.

• Abnormal brain function.

• To evaluate the functioning of other organs, the doctor may order the following test-

• Echocardiogram.

• Complete blood count.

• Bronchoscopy.

• Urinalysis.

• Chest radiograph.

What Are the Exams and Tests Conducted?

The doctor will ask about the sequence that occurred during the event. The doctor will also enquire about:

• Any such events in the past.

• Other medical conditions.

• Any medications or herbs given to the baby.

• Any medication the child would have taken.

• Any complications during pregnancy or labor.

• Any other children at home have experienced the same type of events.

If the doctor feels more testing is required, then they look for:

• The form of the event that occurred.

• The severity of the symptoms.

• The sequence of actions that occurred before the event.

• Other health conditions.

Along with this, a complete physical examination will be performed where:

• Any signs of infection, abuse, or trauma are analyzed.

• Reduced level of oxygen.

• Different heart sounds.

• Signs of defective birth that affect the face, throat, or neck.

• No normal functioning of the brain.

What Is the Differential Diagnosis?

The conditions that show symptoms similar to the brief resolved unexplained event are as follows:

• Pertussis - A bacteria known as Bordetella pertussis is known to cause a respiratory infection called pertussis. It causes symptoms within days after exposure to infection. First, it leads to a runny nose, mild fever, cough, and breathing difficulties. The condition may worsen after one to two weeks, causing rapid cough and vomiting.

• Seizures - Abnormal activity of the brain may lead to uncontrolled movements of the limbs. Certain disorders, infections, or medications may trigger attacks in babies. It may lead to confusion, jerking movements, and loss of consciousness.

• Infant Botulism - The large bowel of babies is infected with Clostridium botulinum leading to a condition called infant botulism. The affected infant may have constipation, weakened muscle tone, breathing, and swallowing difficulties.

• Child Abuse - Intentionally harming a child by physical, emotional, mental, or sexual means may affect their physical and psychological health. It needs to be considered while diagnosing briefly resolved unexplained events in a child.

How Is BRUE Managed?

The event is transient and does not require any medications for management. However, the doctor may educate the parents and caregivers regarding BRUE and the following advice:

• First, make the baby lie on the back while sleeping; the face is set free.

• Avoid exposure to tobacco and its products.

• Practice the proper feeding habits, including holding the infant upright, burping after every feed, and avoiding overfeeding.

• The doctor may suggest nasal saline drops to relieve nasal congestion.

• Use a firm mattress and a light sheet to shield the baby.

• The healthcare specialist also provides cardiopulmonary resuscitation (CPR) training to aid in future emergency events.

• Discuss with the doctor any change in feeding and medications to avoid unnecessary problems.

• Have a regular follow-up.

Conclusion:

The actual frequency of brief resolved unexplained events (BRUE) is unknown. However, it is not a critical condition and lasts for a few seconds. The event usually resolves on its own and rarely necessitates hospitalization. In addition, the proper diagnosis by the doctor is crucial in providing the best treatment. The diagnosis mainly constitutes the physical examination and history taking, including the incidents that happened before, during, and after BRUE. Therefore, a combined effort of health care professionals and the parent or caretaker is essential in managing such events.