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American Academy of Pediatrics
Article

SIDS, BRUE, and Safe Sleep Guidelines

Maria Behnam-Terneus and Melissa Clemente
Pediatrics in Review September 2019, 40 (9) 443-455; DOI: https://doi.org/10.1542/pir.2017-0259
Maria Behnam-Terneus
*Division of Pediatric Hospital Medicine and
†Medical Education Department, Nicklaus Children’s Hospital/Nicklaus Children’s Health System, Miami, FL
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Melissa Clemente
*Division of Pediatric Hospital Medicine and
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  1. Maria Behnam-Terneus, DO*,†
  2. Melissa Clemente, MD*
  1. *Division of Pediatric Hospital Medicine and
  2. †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.

  • Abbreviations:
    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:

    1. 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.

    2. Apply the new BRUE guidelines and risk stratification to determine lower-risk versus higher-risk patients.

    3. Review management recommendations for lower-risk BRUE.

    4. Delineate risk factors and prevention recommendations for SIDS.

    5. 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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    Pediatrics in Review: 40 (9)
    Pediatrics in Review
    Vol. 40, Issue 9
    1 Sep 2019
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    SIDS, BRUE, and Safe Sleep Guidelines
    Maria Behnam-Terneus, Melissa Clemente
    Pediatrics in Review Sep 2019, 40 (9) 443-455; DOI: 10.1542/pir.2017-0259

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    SIDS, BRUE, and Safe Sleep Guidelines
    Maria Behnam-Terneus, Melissa Clemente
    Pediatrics in Review Sep 2019, 40 (9) 443-455; DOI: 10.1542/pir.2017-0259
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    • Article
      • Practice Gaps
      • Objectives
      • Introduction
      • Definitions
      • Epidemiology
      • Brue Evaluation and Diagnosis
      • Safe Infant Sleep Recommendations and Apnea Monitors
      • Acknowledgment
      • References
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