This clinical practice guideline from the American Academy of Pediatrics (AAP) applies to infants aged <1 year and to patients who have experienced a brief resolved unexplained event (BRUE) and provides evidence-based management recommendations for lower-risk patients whose history and physical examination are normal. Among the key recommendations:

• Clinicians should us the term BRUE, rather than the term ALTE (apparent life-threatening event) to describe an event occurring in an infant aged <1 year when the observer reports a sudden, brief, and now resolved episode of ≥1 of the following:

◊ Cyanosis or pallor.

◊ Absent, decreased, or irregular breathing.

◊ Marked change in tone (hyper- or hypotonia).

◊ Altered level of responsiveness.

• For infants who have experienced a BRUE, a careful history and physical examination are necessary to characterize the event, assess the risk of recurrence, and determine the presence of an underlying disorder.

• Infants at low risk of adverse outcomes have the following characteristics:

◊ Age >60 day.

◊ Prematurity: gestational age ≥32 weeks and postconceptional age ≥45 weeks.

◊ First BRUE (no previous BRUE ever and not occurring in clusters).

◊ Duration of event <1 minute.

◊ No CPR required by trained medical provider.

◊ No concerning historical features (see Table 2).

◊ No concerning physical examination findings.

• The recommendations for management of BRUE apply only to low-risk infants.

• Recommendations for work-up include:

◊ There is no need to admit patients to the hospital for monitoring and no need to get blood work, chest x-rays, EEGs, studies for GERD, prescribe therapy for GERD, or initiate home monitoring.

◊ Clinicians may choose to check for pertussis, obtain an EKG, and “briefly monitor patients with continuous pulse oximetry and serial observations.”

Citation: Tieder JS, Bonkowsky JL, Etzel RA, et al. Brief resolved unexplained events (formerly apparent life-threatening events) and evaluation of lower-risk infants. [Published online ahead of print April 25, 2016]. Pediatrics. doi:10.1542/peds.2016-0590.

Commentary: Changes in nomenclature are always difficult and take a long time until they become actually implemented in clinical practice. The replacement of ALTE with BRUE is a welcome change and hopefully will be embraced by clinicians. ALTE never really made sense as was a very threatening name associated with a condition that has excellent outcomes in most children with those episodes. BRUE, a brief resolved unexplained event, is a more accurate description of the event as it is experienced. It is important to realize the term BRUE applies when there is not a readily identifiable cause, meaning for instance that a child with fever and lung findings on exam may have pneumonia as the cause of the apneic episode, not BRUE. In addition, it is important to emphasize that the recommendations in these guidelines apply to low risk infants, as defined above. These guidelines provide a needed approach to a problem that generates a great deal of concern and now has a clear, low-tech method for evaluation and management. —Neil Skolnik, MD