title: Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants.
abstract: This is the first clinical practice guideline from the American Academy of 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). Second, it provides an approach to patient evaluation that is based on the risk that the infant will have a repeat event or has a serious underlying disorder. Finally, it provides management recommendations, or key action statements, for lower-risk infants. The term BRUE is defined as an event occurring in an infant younger than 1 year when the observer reports a sudden, brief, and now resolved episode of ≥1 of the following: (1) cyanosis or pallor; (2) absent, decreased, or irregular breathing; (3) marked change in tone (hyper- or hypotonia); and (4) altered level of responsiveness. A BRUE is diagnosed only when there is no explanation for a qualifying event after conducting an appropriate history and physical examination. By using this definition and framework, infants younger than 1 year who present with a BRUE are categorized either as (1) a lower-risk patient on the basis of history and physical examination for whom evidence-based recommendations for evaluation and management are offered or (2) a higher-risk patient whose history and physical examination suggest the need for further investigation and treatment but for whom recommendations are not offered. This clinical practice guideline is intended to foster a patient- and family-centered approach to care, reduce unnecessary and costly medical interventions, improve patient outcomes, support implementation, and provide direction for future research. Each key action statement indicates a level of evidence, the benefit-harm relationship, and the strength of recommendation.
authors.forename: Joel S
authors.initials: JS
authors.lastname: Tieder
authors.forename: Joshua L
authors.initials: JL
authors.lastname: Bonkowsky
authors.forename: Ruth A
authors.initials: RA
authors.lastname: Etzel
authors.forename: Wayne H
authors.initials: WH
authors.lastname: Franklin
authors.forename: David A
authors.initials: DA
authors.lastname: Gremse
authors.forename: Bruce
authors.initials: B
authors.lastname: Herman
authors.forename: Eliot S
authors.initials: ES
authors.lastname: Katz
authors.forename: Leonard R
authors.initials: LR
authors.lastname: Krilov
authors.forename: J Lawrence
authors.initials: JL
authors.lastname: Merritt
authors.forename: Chuck
authors.initials: C
authors.lastname: Norlin
authors.forename: Jack
authors.initials: J
authors.lastname: Percelay
authors.forename: Robert E
authors.initials: RE
authors.lastname: Sapién
authors.forename: Richard N
authors.initials: RN
authors.lastname: Shiffman
authors.forename: Michael B H
authors.initials: MB
authors.lastname: Smith
mesh_terms: D001049:Apnea / Q000175:diagnosis*; D003490:Cyanosis / Q000175:diagnosis*; D004630:Emergencies; D006801:Humans; D007223:Infant; D009123:Muscle Hypotonia / Q000175:diagnosis*; D012307:Risk Factors; D013398:Sudden Infant Death / Q000175:diagnosis; D009626:Terminology as Topic