TABLE 1

Summary of Key Action Statements for Lower-Risk BRUEs

When managing an infant who is >60 d and <1 y of age and who, on the basis of a thorough history and physical examination, meets criteria for having experienced a lower-risk BRUE, clinicians:Evidence Quality; Strength of Recommendation
1. Cardiopulmonary Evaluation
 1A. Need not admit infants to the hospital solely for cardiorespiratory monitoring.B; Weak
 1B. May briefly monitor patients with continuous pulse oximetry and serial observations.D; Weak
 1C. Should not obtain chest radiograph.B; Moderate
 1D. Should not obtain a measurement of venous or arterial blood gas.B; Moderate
 1E. Should not obtain an overnight polysomnograph.B; Moderate
 1F. May obtain a 12-lead electrocardiogram.C; Weak
 1G. Should not obtain an echocardiogram.C; Moderate
 1H. Should not initiate home cardiorespiratory monitoring.B; Moderate
2. Child Abuse Evaluation
 2A. Need not obtain neuroimaging (CT, MRI, or ultrasonography) to detect child abuse.C; Weak
 2B. Should obtain an assessment of social risk factors to detect child abuse.C; Moderate
3. Neurologic Evaluation
 3A. Should not obtain neuroimaging (CT, MRI, or ultrasonography) to detect neurologic disorders.C; Moderate
 3B. Should not obtain an EEG to detect neurologic disorders.C; Moderate
 3C. Should not prescribe antiepileptic medications for potential neurologic disorders.C; Moderate
4. Infectious Disease Evaluation
 4A. Should not obtain a WBC count, blood culture, or cerebrospinal fluid analysis or culture to detect an occult bacterial infection.B; Strong
 4B. Need not obtain a urinalysis (bag or catheter).C; Weak
 4C. Should not obtain chest radiograph to assess for pulmonary infection.B; Moderate
 4D. Need not obtain respiratory viral testing if rapid testing is available.C; Weak
 4E. May obtain testing for pertussis.B; Weak
5. Gastrointestinal Evaluation
 5A. Should not obtain investigations for GER (eg, upper gastrointestinal tract series, pH probe, endoscopy, barium contrast study, nuclear scintigraphy, and ultrasonography).C; Moderate
 5B. Should not prescribe acid suppression therapy.C; Moderate
6. Inborn Error of Metabolism Evaluation
 6A. Need not obtain measurement of serum lactic acid or serum bicarbonate.C; Weak
 6B. Should not obtain a measurement of serum sodium, potassium, chloride, blood urea nitrogen, creatinine, calcium, or ammonia.C; Moderate
 6C. Should not obtain a measurement of venous or arterial blood gases.C; Moderate
 6D. Need not obtain a measurement of blood glucose.C; Weak
 6E. Should not obtain measurements of urine organic acids, plasma amino acids, or plasma acylcarnitines.C; Moderate
7. Anemia Evaluation
 7A. Should not obtain laboratory evaluation for anemia.C; Moderate
8. Patient- and Family-Centered Care
 8A. Should offer resources for CPR training to caregiver.C; Moderate
 8B. Should educate caregivers about BRUEs.C; Moderate
 8C. Should use shared decision making.C; Moderate
  • CPR, cardiopulmonary resuscitation; CT, computed tomography; GER, gastroesophageal reflux; WBC, white blood cell.