BRUE

Question 1

Define BRUE.

Answer 1

An event that is frightening to the observer with a combination of: apnoea, colour change (purple, blue or pale), change in muscle tone (floppy or still) and choking/gagging.

<1 minute and not explained by a medical condition. Changes in colour, tone, conscious and respiratory state.

Question 2

What can be said about the significance of BRUEs?

Answer 2

No association with SIDS and in >95% of the time there is a benign of physiological cause to blame

Question 3

What is the ddx for an BRUE?

Answer 3

Pathological: respiratory infection, sepsis, cardiac (long QT, congenital heart disease), neurological (tumour, seizure, injury), abdominal (torsion, strangulated hernia, intussusception), metabolic problems (hypoglycaemia), child abuse, drugs/toxins
Benign: exaggerated cough reflex, periodic breathing of the newborn

Question 4

What is the most common cause for an BRUE?

Answer 4

Respiratory infections (coryza, bronchiolitis, pertussis), GORD

Question 5

What is periodic breathing of the newborn?

Answer 5

Apnoeas <20 seconds

Question 6

What are the important questions to ask on history with an BRUE?

Answer 6

Event: sleep/awake, colour + tone, seizure-like activity.
Preceding: recent feed/vomit, sleeping position, sleeping environment.
Recent illness: cough, coryza, URTI/LRTI, pmhx (prem, heart/lung disease, immunisations), social situation

Question 7

What are the important exam findings in an BRUE?

Answer 7

1) Appearance
2) Hydration
3) Vitals
4) Parent-child interaction
5) Neuro exam (fontanelle too)
6) Cardiorespi (HF signs, URTI/LRTI)
7) Trauma/NAI evidence (? fundoscopy)

Question 8

What children are most at risk for adverse outcome after a BRUE?

Answer 8

1) Neonates
2) Premature/low birth weight/twin/multiple birth
3) Prior medical illness
4) Looks unwell/toxic
5) Recurrent event before presentation
6) Prolonged episode
7) Long QT on ECG

Question 9

What investigations may you consider for a BRUE?

Answer 9

Bedside: BSL, ECG
Lab: septic screen, electrolytes, NPA for viruses + pertussis

Consider: NAI ix, metabolic screen, EEG, CT brain, Holter, urine tox screen

Question 10

What is the management for BRUE?

Answer 10

Admit for observation, treat underlying cause(s), parental education + reassurance

Question 11

A lower risk BRUE occurs when there are no concerning features on history or examination:

Answer 11

Age > 60 days
Born ≥ 32 weeks gestation and corrected gestational age ≥ 45 weeks
No CPR by trained healthcare professional
First event (cannot be lower risk if event has been repeated)
event lasted < 1 minute