Patient handout

Brief Resolved Unexplained Event (BRUE)

PRODUCTION

1. Your condition

This handout is for brief resolved unexplained event (brue). Your care team identified this based on: brief (<1 min) resolved episode in infant <1 yr with cyanosis/pallor, breathing change, tone change, or altered responsiveness (aap 2016 tieder pmid 27244835).

Other reasons your team may use this plan: cyanotic or pallid spell in infant <1 yr — caregiver report (aap 2016 tieder); apneic or breathing-irregularity episode in infant <1 yr, now well (aap 2016 tieder); altered tone (hyper-/hypotonia) or altered responsiveness episode, resolved (aap 2016 tieder).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
NO routine pharmacotherapy for lower-risk BRUE	Brief monitored observation 1-4 h + caregiver CPR teaching + reassurance + close 24 h PCP follow-up + return precautions	—	—	AAP 2016 Tieder — lower-risk BRUE does not warrant routine labs, imaging, EEG, CXR, echo, hospitalization, or medications; supportive observation + caregiver education is the standard

Plan: Lower-risk BRUE — supportive care + caregiver education (AAP 2016 Tieder PMID 27244835) — NO routine medications

3. When to call your provider

Contact your care team if any of the following happen:

New BRUE event reported by caregiver → return to ED + admit + intensify workup (AAP 2016 Tieder)
New focal neurologic finding → return to ED + neuro consult + EEG (AES 2016)
New cardiac symptom (cyanosis at rest, exercise intolerance) → cardiology referral + ECG / echo (AAP 2016 Tieder)
New abuse concern → CPS notification + child abuse pediatrics referral (AAP 2020 Christian)
Failure to thrive or developmental regression → return to ED OR urgent peds visit (AAP 2016 Tieder)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Higher-risk BRUE — any AAP 2016 lower-risk criterion fails: age ≤60 d OR GA <32 wk OR PMA <45 wk OR event duration ≥60 s OR recurrent event OR CPR by trained provider OR any concerning history/exam feature (AAP 2016 Tieder PMID 27244835)
BRUE with concerning features for abuse — bruising in non-mobile infant, retinal hemorrhages, abnormal neuro exam, inconsistent history, prior CPS involvement, social-risk concerns (AAP 2016 Tieder; AAP 2020 Christian abusive head trauma)(life-threatening)
BRUE with seizure features — focal motor activity, clonic movements, gaze deviation, postictal state, or recurrent stereotyped events (AAP 2016 Tieder; AES 2016)
BRUE with cardiac concern — abnormal ECG (long-QT, WPW, hypertrophic cardiomyopathy pattern), murmur, family history of sudden cardiac death or channelopathy, syncope with effort, or cyanosis without respiratory cause (AAP 2016 Tieder)
BRUE with metabolic concern — recurrent BRUE, family history of inborn error of metabolism or unexplained infant death, hypoglycemia, hyperammonemia, lactic acidosis, abnormal newborn screen, dysmorphic features, hepatomegaly, developmental regression (AAP 2016 Tieder)
Recurrent BRUE — second or subsequent event in same infant (AAP 2016 Tieder)
Unexplained BRUE in infant <4 mo or unvaccinated infant (AAP 2016 Tieder; Red Book 2021 CDC)

5. Follow-up

Lower-risk: PCP follow-up within 24 h (telephone + in-person at 24-72 h); reinforce CPR teaching; review return precautions (any new event, color change, breathing concern, feeding difficulty, lethargy → ED); discuss safe sleep (back-to-sleep, room-sharing not bed-sharing, smoke-free home) and breastfeeding promotion (AAP 2016 Tieder; AAP 2022 Moon safe sleep). Higher-risk: outpatient pediatric subspecialist follow-up based on workup findings (cardiology, neurology, GI, metabolism, child abuse / CPS); developmental surveillance (AAP 2016 Tieder)

6. Sources

Guideline: AAP 2016 Clinical Practice Guideline — Brief Resolved Unexplained Events (BRUE) in lower-risk infants (Tieder et al, Pediatrics 2016) + AAP 2020 Christian abusive head trauma technical report + AAP 2021 Pantell febrile infant CPG (for febrile BRUE overlap) + AAP 2022 Moon safe sleep + Red Book 2021 (pertussis) + NASPGHAN 2018 Rosen (GERD) + AES 2016 (seizure)