Key takeaways: A BRUE (brief resolved unexplained event) is a sudden event in a baby under 1 year, lasting less than a minute, involving color change, breathing changes, a change in muscle tone, or reduced responsiveness, with a return to normal and no clear cause after an exam. Lower-risk babies often need little testing. Any such event needs prompt medical evaluation.
A BRUE can be terrifying for parents. Here’s what it means.
What Is a BRUE?
In 2016, the AAP replaced the term “ALTE” (apparent life-threatening event) with BRUE. A BRUE happens in a baby under 1 year and includes one or more of the following, lasting less than 1 minute:
- Color change: turning blue or pale (not just red in the face).
- Breathing change: absent, decreased, or irregular breathing.
- Tone change: becoming very stiff or very floppy.
- Altered responsiveness.
Then the baby returns to their normal state, and no explanation is found after a careful history and exam.
Common Explanations That Aren’t BRUE
Doctors look for explained causes first, such as:
- Choking on spit-up or milk during feeding.
- Normal periodic breathing in newborns.
- Breath-holding.
- Infection, seizure, heart problem, or abuse.
Lower-Risk BRUE
The AAP guideline describes babies at lower risk:
- Older than 60 days.
- Born at 32 weeks or later and now at least 45 weeks corrected age.
- First event.
- Lasted less than 1 minute.
- No CPR by a trained provider needed.
- No concerning findings on history or exam.
For lower-risk babies, the guideline suggests limited testing and education, and many can go home.
Higher-Risk Babies
Babies who don’t meet lower-risk criteria may need more testing and hospital observation.
After a BRUE
- Learn infant CPR.
- Follow safe sleep practices.
- Follow up with your pediatrician.
Call 911 if your baby: stops breathing, turns blue or gray, becomes limp or unresponsive. Seek prompt medical care after any such event, even if your baby seems fine now.
The Bottom Line
A BRUE is frightening, and every event needs evaluation. Many babies are lower-risk and do well.
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Sources
- Tieder JS, Bonkowsky JL, Etzel RA, et al; Subcommittee on Apparent Life Threatening Events. Brief resolved unexplained events (formerly apparent life-threatening events) and evaluation of lower-risk infants. Pediatrics. 2016;137(5):e20160590.
- American Academy of Pediatrics. Brief resolved unexplained event (BRUE): what parents need to know. HealthyChildren.org. https://www.healthychildren.org
This article is for general education and is not a substitute for individualized medical advice. Always talk with your baby’s health care provider or your own provider about your specific situation. If you think your baby or you may have a medical emergency, call 911.
