Symposium: intensive careApparent Life-Threatening Events (ALTE) or Brief Resolved Unexplained Events (BRUE)

Apparent life-threatening events (ALTE) have recently been renamed by the American Academy of Pediatrics to “Brief Resolved Unexplained Events” (BRUE), which include events with cyanosis or pallor; absent, decreased, or irregular breathing; marked change in tone, and an altered level of responsiveness, with no explanation being found during an initial work-up. Epidemiologically, low and high risk events can be identified. Low-risk events occur in children more than 60 days of age, with birth at ≥32 weeks gestation, no previous event, an estimated duration less than 1 minute, no need for resuscitation by trained medical personnel and no concerning historical features or physical examination findings. Low-risk events usually do not require hospital admission, an extensive diagnostic work-up or home monitoring. In contrast, children with high-risk events should be admitted and carefully monitored. Where available, provision of a memory monitor for home use for 4-6 weeks can help to identify treatable pathologies. Important risk factors for future events include a history of prematurity, multiple ALTE and suspected child maltreatment. Finally, the separate entity of neonatal ALTE, often related to positional upper airway obstruction, should be considered, as these may be best prevented by instructing parents and midwives to ensure that their baby's airway remains unobstructed at all times.