Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants: Executive Summary

* Abbreviations: ALTE — : apparent life-threatening event BRUE — : brief resolved unexplained event SIDS — : sudden infant death syndrome This clinical practice guideline has 2 primary objectives. First, it recommends the replacement of the term “apparent life-threatening event” (ALTE) with a new term, “brief resolved unexplained event” (BRUE). Second, it provides an approach to evaluation and management that is based on the risk that the infant will have a repeat event or has a serious underlying disorder. Clinicians should use the term BRUE to describe an event occurring in an infant younger than 1 year when the observer reports a sudden, brief, and now resolved episode of ≥1 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. Moreover, clinicians should diagnose a BRUE only when there is no explanation for a qualifying event after conducting an appropriate history and physical examination (see Tables 2 and 3 in www.pediatrics.org/cgi/doi/10.1542/peds.2016-0590). Among infants who present for medical attention after a BRUE, the guideline identifies (1) lower-risk patients on the basis of history and physical examination, for whom evidence-based guidelines for evaluation and management are offered, and (2) higher-risk patients, whose history and physical examination suggest the need for further investigation, monitoring, and/or treatment, but for whom recommendations are not offered (because of insufficient evidence or the availability of guidance from other clinical practice guidelines specific to their presentation or diagnosis). Recommendations in this guideline apply only to lower-risk patients, who …