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.
From the author
From First Breath to First Birthday is my month-by-month guide to your baby’s first year, written as a NICU and postpartum nurse. My book covers common first-year illnesses and the warning signs that mean it’s time to call the doctor, explained the way I’d explain them at the bedside.
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.
Want more support for your baby’s first year? My book, From First Breath to First Birthday, is available on Amazon.
Related Articles
- Breath-Holding Spells
- Going Home Early: What to Watch for if You Leave Before 48 Hours
- Infant CPR: What Every Parent Should Know
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.
