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- Maria Behnam-Terneus, DO*,†
- Melissa Clemente, MD*
- *Division of Pediatric Hospital Medicine and
- †Medical Education Department, Nicklaus Children’s Hospital/Nicklaus Children’s Health System, Miami, FL
AUTHOR DISCLOSURE
Drs Behnam-Terneus and Clemente have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
- AAP:
- American Academy of Pediatrics
- ALTE:
- apparent life-threatening event
- BRUE:
- brief resolved unexplained event
- CPSC:
- Consumer Product Safety Commission
- SIDS:
- sudden infant death syndrome
- SUID:
- sudden unexpected infant death
Practice Gaps
In 2016, the American Academy of Pediatrics (AAP) published a clinical practice guideline in which they recommended redefining apparent life-threatening event with the more specific term brief resolved unexplained event (BRUE). The purpose of this review is to detail how to apply the BRUE classification guidelines in practice. The recently updated AAP guidelines for sudden infant death syndrome prevention and safe infant sleeping environment are also discussed.
Objectives
After completing this article the reader should be able to:
Distinguish and explain the defining characteristics and epidemiology of sudden unexpected infant death, sudden infant death syndrome (SIDS), brief resolved unexplained event (BRUE), and apparent life-threatening event.
Apply the new BRUE guidelines and risk stratification to determine lower-risk versus higher-risk patients.
Review management recommendations for lower-risk BRUE.
Delineate risk factors and prevention recommendations for SIDS.
Explain the updated American Academy of Pediatrics recommendations for a safe infant sleeping environment.
Introduction
In April 2016, the American Academy of Pediatrics (AAP) published a new clinical practice guideline for brief resolved unexplained events (BRUEs). This new term, risk classification, and management recommendations replaced what was formerly known as an apparent life-threatening event (ALTE). BRUE describes transient events without a clear etiology after a thorough medical evaluation by a clinician, in contrast to ALTE, in which the definition refers to the subjective experience of a frightening event by a caregiver is detailed. In addition, the new guideline recommendations differentiate a BRUE from episodes that might warrant further investigation secondary to an increased risk of a serious underlying condition.
The purpose of this review is to clarify the differences between these 2 definitions, as well as to distinguish them …
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