Pedemy All toolsAnswer one question at a time. The result gives the next steps for lower-risk and higher-risk infants. Tap any earlier answer to change it.
This tool helps clinicians decide whether an infant’s event meets the definition of a brief resolved unexplained event (BRUE) and whether the infant is lower risk under the AAP guideline. It then gives next steps for lower-risk and higher-risk infants.
A BRUE occurs in an infant under 1 year, is sudden, brief (usually under 1 minute) and resolved, and includes cyanosis or pallor, absent, decreased or irregular breathing, a marked change in tone, or altered responsiveness, with no explanation after a careful history and exam. Explained events and infants still symptomatic are directed elsewhere. To be lower risk, the infant must meet every criterion: age over 60 days, gestational age 32 weeks or more with postconceptional age 45 weeks or more, a first event not in a cluster, duration under 1 minute, no CPR by a trained provider, and no concerning history or exam findings.
For lower-risk infants the tool lists what may be done (brief pulse oximetry monitoring for 1–4 hours, pertussis testing, 12-lead ECG) and the tests and treatments that should not be done, along with discharge advice. For higher-risk infants it suggests evaluation guided by the risk factor. It is based on Tieder et al., Pediatrics 2016 (AAP).
All must be met: age over 60 days; gestational age 32 weeks or more and postconceptional age 45 weeks or more; first event, not in a cluster; event under 1 minute; no CPR by a trained medical provider; and no concerning history or exam findings.
Routine tests are not needed. The tool lists brief monitoring with pulse oximetry for 1–4 hours, pertussis PCR if there is exposure or incomplete vaccination, and a 12-lead ECG as options. Blood tests, imaging, EEG, reflux medicines and home apnea monitors should not be used, and admission just for monitoring is not advised.
According to the discharge advice in the tool, these events are usually harmless and do not raise the risk of SIDS. Families should be offered infant CPR training and safe sleep advice, and told to return if another event happens.
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