What is a Brue episode?

A Brief Resolved Unexplained Event (BRUE) happens suddenly and can be scary for parents and caregivers. When a BRUE occurs, babies may seem to stop breathing. Their skin color may change to pale or blue. Their muscles may relax or tighten.

What do I do if my baby has a BRUE?

What causes brues?

Most bruises form when small blood vessels (capillaries) near the skin's surface are broken by the impact of a blow or injury — often on the arms or legs. When this happens, blood leaks out of the vessels and initially appears as a dark mark. Eventually the body reabsorbs the blood, and the mark disappears.

When does BRUE happen?

A brief resolved unexplained event (BRUE) is when an infant younger than one year stops breathing, has a change in muscle tone, turns pale or blue in color, or is unresponsive. The event occurs suddenly, lasts less than 30 to 60 seconds, and is frightening to the person caring for the infant.

How long does a BRUE last?

A BRUE is a description of a self-limited episode. Usually a BRUE lasts for less than 1 minute. By definition, the episode must have resolved by the time the infant is evaluated by a medical professional. The caregiver may report observation of bluish skin discoloration, called cyanosis.

"Approach to Brief Resolved Unexplained Events (BRUE)" by Jonathan Fried and Beth Harper

How is BRUE diagnosed?

BRUE is a diagnosis made after the care team has examined your baby and determined that there was no known concerning cause for the event. Though we can never say that a baby who has had a BRUE is at no risk for future problems, we can say that babies are at lower risk if: They are older than 60 days.

What is high risk BRUE?

HIGHER-RISK BRUE

There was generally an increased risk from prematurity in infants born at <32 weeks' gestation, and the risk attenuated once infants born at <32 weeks' gestation reached 45 weeks' postconceptional age.

Can GERD cause BRUE?

Despite evidence in the literature that GERD is not a significant cause for BRUE episodes, more than one-third of patients were placed on acid -suppression therapy during or following the BRUE admission.

Is Laryngomalacia serious?

In most cases, laryngomalacia in infants is not a serious condition — they have noisy breathing, but are able to eat and grow. For these infants, laryngomalacia will resolve without surgery by the time they are 18 to 20 months old.

Why do babies suddenly stop breathing?

Breath-holding is when a baby or child stops breathing for up to 1 minute and may faint. It can happen when a child is frightened, upset, angry, or has a sudden shock or pain. It's usually harmless but can be scary for parents, particularly when it happens for the first time.

What are the first signs of internal bleeding?

What is Alte Brue?

BRUE (brief, resolved, unexplained event) and ALTE (apparent life-threatening event) are not specific disorders but terms for a group of alarming symptoms that can occur in infants. They involve the sudden appearance of respiratory symptoms (eg, apnea), change in color or muscle tone, and/or altered responsiveness.

When does a hematoma need to be drained?

Sometimes, a hematoma may require surgical drainage. Surgery may be more likely if the blood is putting pressure on the spinal cord, brain, or other organs. In other cases, doctors may want to drain a hematoma that is at risk of infection.

Why is my baby's head floppy?

Children with hypotonia have symptoms where their body resembles a rag doll. Healthcare providers might refer to your baby being “floppy” from their diagnosis. Symptoms of hypotonia include: Your baby is unable to lift their head or control neck muscles.

Why is my baby gasping for air in sleep?

Symptoms of sleep apnea vary from child to child. Loud snoring, which may be followed by pauses in breathing or gasping for air, is the most common symptom.

Why is my baby making gasping noises?

Laryngomalacia is a common cause of noisy breathing in infants. It happens when a baby's larynx (or voice box) is soft and floppy. When the baby takes a breath, the part of the larynx above the vocal cords falls in and temporarily blocks the baby's airway.

Can laryngomalacia cause brain damage?

Laryngomalacia has been related to the sleep state,⁶ brain injury,¹² and neurologic disorders including seizure disorder and cerebral palsy. Several authors have noted poorer results of therapeutic intervention when a history of associated neurologic conditions is present.

Can laryngomalacia be fatal?

Is laryngomalacia life threatening? Despite the associated noisy breathing, laryngomalacia is usually not dangerous, as most babies with the condition are still able to breathe. While most infants outgrow laryngomalacia, a few cases will require surgery to correct the issue.

Can laryngomalacia cause SIDS?

A short list of possible causes include gastroesophageal reflux, seizures, CCHS, respiratory infection, laryngomalacia (floppy airway that causes noisy breathing), congenital heart defect, heart rhythm problem, sepsis (overwhelming body infection), and child abuse.

Is GERD life-threatening in babies?

GERD is one of the causes of acute life-threatening episodes in infants and has been associated with chronic respiratory disorders, including reactive airway disease, recurrent stridor, chronic cough and recurrent pneumonia in infants.

What is an unexplainable event called?

The American Academy of Pediatrics published a clinical practice guideline in 2016 recommending replacing the term apparent life-threatening event (ALTE) with a new term named brief resolved unexplained event (BRUE)[1][2].

Can reflux make babies blue?

Most babies can thrive despite silent reflux. But seek medical attention if your child has: breathing difficulties (for example, you hear wheezing, notice labored breathing, or your baby's lips are turning blue) a frequent cough.

What percentage of emergency departments does BRUE constitute?

According to a previous report, BRUE account for 0.6%-0.8% of all emergency room visits for infants younger than one year [4]. However, the true prevalence of BRUE is unknown, and it is estimated that 0.5%-0.6% of healthy term infants have experienced BRUE [5].

What are life threatening events?

"An apparent life-threatening event (ALTE) is defined as an episode that is frightening to the observer and is characterized by some combination of apnea (central or obstructive), color change (cyanotic, pallid, erythematous or plethoric) change in muscle tone (usually diminished), and choking or gagging.

What is the new term for ALTE?

Pediatrics that specifically applies to patients who have experienced an apparent life-threatening event (ALTE). This clinical practice guideline has 3 objectives. First, it recommends the replacement of the term ALTE with a new term, brief resolved unexplained event (BRUE).