All children who present for evaluation of an apparent life-threatening event (ALTE) or brief resolved unexplained event (BRUE) should have which of the following evaluations?
D. Evaluation for child abuse and maltreatment
An ALTE and the newer term, BRUE, is defined as an event in an infant younger than 1 year of age in which an observer reports a sudden, brief, now-resolved episode of one or more of the following: 1) cyanosis or pallor; 2) absent, decreased, or irregular breathing; 3) marked change in tone (hyper- or hypotonia); and 4) altered level of responsiveness. All children presenting for evaluation of BRUE should be assessed for child maltreatment with a careful history and physical exam. While nonaccidental trauma accounts for less than 5% of the cause of ALTE, because child abuse may take many different forms, all of which are difficult to diagnose, it should be ruled out during the evaluation of BRUE. While MRI of the brain, chest x-ray, and pH probe may be useful in the evaluation of BRUE if history and physical indicate a specific cause of the event, these tests are not indicated in all infants presenting with BRUE.
Reference: Fu LY, Moon RY. Apparent life-threatening events: an update. Pediatr Rev. 2012;33(8):361-368. Pubmed ID: 22855928.
Which of the following is not included in the criteria for BRUE according to the 2016 American Academy of Pediatrics (AAP) guidelines?
A. Child older than 12 months
BRUEs, formerly ALTEs, occur in infants younger than 1 year old, are brief (last approximately 20 to 30 seconds), and include one or more of the following: (1) cyanosis or pallor, (2) absent, decreased, or irregular breathing (3) hypertonia or hypotonia, and (4) altered level of consciousness.
Reference: Tieder JS, Bonkowsky JL, Etzel RA, et al; 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;137(5). pii: e20160591. Pubmed ID: 27244836.
According to the 2016 AAP guidelines for BRUE, which of the following would increase the possibility of a serious cause of BRUE?
A. Age older than 60 days