Brief Resolved Unexplained Event (BRUE) Instead of ALTE

We have been dealing with the term Apparent Life Threatening Event (ALTE) for decades. The AAP recently released new guidelines addressing this condition for the first time and have appropriately replaced the term ALTE with BRUE (Brief Resolved Unexplained Event) accurately reflecting the clinical situation.

ALTE renamed BRUE

These infants and small children often end up admitted to the hospital for overnight observation and cardiorespiratory monitoring. This is because there was a lack of national guidelines and pediatricians (including experienced and seasoned pediatricians) cannot be 100% confident that there isn’t a serious condition. Even the Nelson Textbook of Pediatrics does not have a chapter named ALTE and messages are confusing to say the least. Nevertheless, most of the times ALTE patients get discharged next day with no specific underlying pathology. This of course is a waste of resources and put families at unnecessary anxiety. Even the term itself (apparent life threatening) scares families and underscores the possibility of a serious underlying condition.

Research have found that most of these events resolve with no further consequences or complications and there is no statistically significant link to SIDS. Specially when major causes are ruled out (cardiac disease, epilepsy, child abuse, congenital malformations, sepsis, and respiratory apnea). Gastroesophageal reflux remains one of the most likely causes but that is not life-threatening unless associated with aspiration pneumonia and significant respiratory compromise.

Thank you AAP for saving us and now we can confidently tell these worried parents (Do Not Worry).

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