BRUE in infancy does not increase risk of death

Michael G Burke, MD

A meta-analysis of 12 studies of the risk of death after a brief resolved unexplained event (BRUE) found that such an event does not increase an infant’s risk of dying during his or her first year. The American Academy of Pediatrics (AAP) introduced BRUE, a sudden alteration in an infant’s breathing, color, tone, or responsiveness, as a replacement for “apparent life-threatening event” (ALTE) in a 2016 clinical practice guideline.

The 12 studies involved 3005 children whose parents sought emergency care for a BRUE (termed ALTE in the pre-2016 studies). Twelve babies died, several in the hospital, within a few days of the event, but most weeks, months, or years later. Specifically, 8 infants died within 3 months of the BRUE and the remaining 4 between 4 months and 5.5 years after the event. The mortality rate after a BRUE, therefore, was 3.1 postevent deaths per month per 10,000 events.

Further analysis, using a 4-month time horizon, determined that the upper bound of the probability of death after a BRUE is about 1 in 800. This compares with a baseline risk of death during a 4-month period in the first year of life of 1 in 1200 for all infants (after excluding neonatal deaths), according to US infant mortality statistics (Brand DA, et al. J Pediatr. February 2, 2018; Epub ahead of print).

Thoughts from Dr. Burke

This analysis of existing studies is meant to allow physicians to offer reassurance with minimal evaluation to parents of infants with low-risk BRUEs as defined in the 2016 AAP guideline (Pediatrics. 2016;137(5):e20160590). Low-risk BRUE infants include those who were not premature, were aged 2 months or older at diagnosis, had a first-time BRUE that lasted less than 1 minute, and did not require cardiopulmonary resuscitation by a healthcare professional. This guideline is one to keep close at hand.