Retrospective application of brief resolved unexplained event (BRUE) criteria on infants admitted with ALTE or suspected sepsis: a 5-year analysis in a single tertiary center in Western Saudi Arabia

Abstract

Background: In 2016, the American Academy of Pediatrics (AAP) proposed a criteria definition and management guidelines for brief resolved unexplained events (BRUE) in replacement of the apparent life-threatening events (ALTE). In this study, we report the findings of a retrospective application of BRUE criteria. We estimated the prevalence of BRUE among neonates and infant’s emergency visits and analyzed and discussed the clinical presentations and management patterns.

Methods: We reviewed the medical charts of 1,212 infants aged less than 1 year who were admitted to the Pediatric Medical Emergency Ward (PMEW) at a tertiary care hospital in Western Saudi Arabia from January 2011 to January 2016. Infants who were discharged with ALTE or without a final diagnosis were assessed regarding the AAP BRUE. Demographic, clinical, and follow-up data were collected and analyzed.

Results: Nineteen infants (12 females, age range = 4-90 days) were retrospectively classified as BRUE, representing 1.6% (95%CI = 1.0-2.4%) of the overall neonates and infants’ visits at the PMEW; 13 of them were initially classified as ALTE; at the same time, the 6 remainders were suspected of sepsis. The most frequently reported symptom was cyanosis (14, 73.7%), followed by absent breathing (11, 57.9%) and altered consciousness (4, 21.1%). Notably, 14 (73.7%) patients had at least 2 concomitant symptoms. The majority (17, 89.5%) met the high-risk criteria. Sixteen out of the 19 benefitted from further investigations and were hospitalized, with a median length of stay of 3 days.

Conclusion: BRUE accounted for 1.6% of the overall neonates and infant emergency visits in our institution, and one-third of them were initially classified other than ALTE. The application of 2016 AAP BRUE guidelines is highly recommended as it offers a practical management strategy for infants who experience non-evident symptoms, guided by a comprehensive assessment of the risk level related to the patient’s history and living environment, regardless of the initial symptom.