Association between vomiting and brief resolved unexplained events in infants: experience from a Tertiary Care Center

Abstract

Background: Gastroesophageal reflux disease (GERD)-related vomiting is a frequent cause of Emergency Department (ED) visits in infants; however, its role in brief resolved unexplained events (BRUE) remains unclear. Dis­tinguishing physiological reflux from GERD-induced BRUE is challenging because descriptions of vomiting are often vague. This study examined the association between vomiting and BRUE, identified potential risk factors, and assessed whether vomiting requires further clinical evaluation.

Methods: This retrospective cohort study evaluated 147 infants under 1 year of age who presented with vomiting at the Pediatric ED of our University Hospital between 2018 and 2019. The data included demographics, clinical symptoms, vomiting characteristics, and final diagnoses. In addition to the primary analysis, a secondary analysis was conducted specifically on infants diagnosed with BRUE based on clinical presentation.

Results: A total of 147 infants with vomiting were included in the study, with a mean age of 6.19 ± 3.15 months. The majority were boys (60%), 25 (17%) left without being seen, and 122 (83%) underwent a full evaluation. Vomiting was often accompanied by fever (23%), apnea (3%), color change (5%), and altered level of consciousness (4%). Most infants were discharged (59%); 23 (16%) were admitted to the Pediatric Medical Ward, and 12 (8%) required Pediatric Intensive Care Unit (PICU) admission. Among the 13 infants with BRUE (9%), 10 (77%) had comorbidities, 6 (46%) were admitted to the Pediatric Medical Ward, and 4 (31%) required PICU admission. The most common BRUE diagnoses were gastritis (31%), bronchopneumonia (23%), and sepsis (23%).

Conclusion: Infants with vomiting should be carefully assessed for BRUE, particularly in the presence of other significant symptoms. Accurate event description is crucial for diagnosis. Larger studies are needed to optimize management, improve outcomes, and reduce unnecessary hospital admissions.