BRUE
| Brief Resolved Unexplained Event - a diagnosis of exclusion | |
|---|---|
| History | - Awake/asleep (sleep-related breathing disorders include OSA and central sleep apnoea) - Position (supine/prone/side) - Muscle tone (stiff/floppy/normal), Movement, incl. eyes (purposeful, repetitive), Respiratory effort (incl. distress, SOB, pauses, apnoea) - Skin and lip colour (incl. cyanosis, pallor, plethora) - Choking/gagging/vomiting - Duration and how it stopped (self-resolved/repositioned/ stimulated/CPR) - Condition after event and whether back to normal - Preceding trauma or recent head injury - Any objects nearby that could cause suffocation - Feeding history Past medical history: - Gestational age (infants born younger than 34 weeks have a high prevalence of apnoea of prematurity) - Perinatal history, including NICU/SCBU - Previous unexplained episodes - Previous resuscitation - Recent illness - - Family history to include: - SUDIC, BRUE in siblings - Cardiac problems including arrhythmias - Parental consanguinity - Social history |
| Examination | - Full ABCDE assessment – consider differential diagnoses. Remember to test a capillary blood glucose. - Fully expose the child to check for bruising, bleeding from nose/mouth, torn frenulum and subconjunctival haemorrhage - Plot weight, length and head circumference - Note any dysmorphic features that might indicate underlying congenital abnormalities |
| Diagnostic investigations | High risk patients - ECG (QT interval), glucose Low risk - none required |
| Definition | Age <12 months <1 minute Return to baseline state In a medically well child |
| Clinical presentation | >= 1 of: – Cyanosis or pallor – Absent, decreased, or irregular breathing – Marked change in tone (hyper- or hypotonia) – Altered level of responsiveness |
| Ddx | Viral bronchiolitis arrhythmias, QT prolongation GORD (due to laryngospasm) seizures, neuromuscular disorders IEM non-accidental injury toxins |
| Management | Low risk patients can potentially be discharged with advice and safety netting. - Age >60 days - Gestational age ≥32 weeks and post-conceptional age ≥45 weeks - Occurrence of only 1 BRUE (no prior BRUE ever and not occurring in clusters) - Duration of BRUE <1 minute - No cardiopulmonary resuscitation by a trained medical provider - No concerning historical features - No concerning physical examination findings Consider Pertussis if vax history is dodgy Consider always non-accidental injury |