BRUE Definition and Factors for Inclusion and Exclusion

BriefDuration <1 min; typically 20–30 sDuration ≥1 min
ResolvedPatient returned to his or her baseline state of health after the eventAt the time of medical evaluation:
Normal vital signs Fever or recent fever
Normal appearance Tachypnea, bradypnea, apnea
 Tachycardia or bradycardia
 Hypotension, hypertension, or hemodynamic instability
 Mental status changes, somnolence, lethargy
 Hypotonia or hypertonia
 Bruising, petechiae, or other signs of injury/trauma
 Abnormal weight, growth, or head circumference
 Noisy breathing (stridor, sturgor, wheezing)
 Repeat event(s)
UnexplainedNot explained by an identifiable medical conditionEvent consistent with GER, swallow dysfunction, nasal congestion, etc
History or physical examination concerning for child abuse, congenital airway abnormality, etc
Event Characterization
 Cyanosis or pallorCentral cyanosis: blue or purple coloration of face, gums, trunkAcrocyanosis or perioral cyanosis
Central pallor: pale coloration of face or trunkRubor
 Absent, decreased, or irregular breathingCentral apneaPeriodic breathing of the newborn
Obstructive apneaBreath-holding spell
Mixed obstructive apnea
 Marked change in tone (hyper- or hypotonia)HypertoniaHypertonia associated with crying, choking, or gagging due to GER or feeding problems
HypotoniaTone changes associated with breath-holding spell
Tonic eye deviation or nystagmus
Tonic-clonic seizure activity
Infantile spasms
 Altered responsivenessLoss of consciousnessLoss of consciousness associated with breath-holding spell
Mental status change
Postictal phase