ALTE has been deprecated and replaced with BRUE. Apparent Life-Threatening Events scared parents and led physicians to unnecessary testing. The American Academy of Pediatrics has issued the following guideline.
BRUE ==== STEP 1: Meets DEFINITION of BRUE - BRIEF: less than 1 minute episode - RESOLVED: back to baseline/normal - UNEXPLAINED: no other etiology (no URI, vomiting, etc) - EVENT: - cyanosis or pallor (not erythema) - absent, decreased or irregular breathing - marked change in tone - altered level of responsiveness - in a normal child, less than 1 year old STEP 2: Stratify as LOW risk - more than 60 days old - full term (gestational age more than 32w) - 1st event and not in clusters - less than 1 minute - no CPR by *trained medical provider* - no concerning features on H&P STEP 3: Consider TREATMENT options for LOW risk - SHOULD DO: educate care giver, shared medical decision making regarding can-do items, CPR training for parents - CAN DO: pertussis testing, ekg, serial observation, pulse oximetry - DONT HAVE TO DO: admit, viral PCR, glucose, HCO3, lactate, Hgb, CT head (unless judgement says differently), UA - SHOULD NOT DO: WBC, CSF, Cx, BMP, urine organic acids, CXR, echo, EEG, GERD tests, H2 blockers, anti-epileptics, no home monitoring HIGH risk patients consider - abuse - cardiac arrhythmias (family history of sudden death) - infection (URI Sx) - others guided by context
- Tieder JS, Bonkowsky JL, Etzel RA, Franklin WH, Gremse DA, Herman B, Katz ES, Krilov LR, Merritt JL 2nd, Norlin C, Percelay J, Sapién RE, Shiffman RN, Smith MB; SUBCOMMITTEE ON APPARENT LIFE THREATENING EVENTS. Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants: Executive Summary. Pediatrics. 2016 May;137(5). https://www.ncbi.nlm.nih.gov/pubmed/27244836