From the Guidelines
For a high-risk Brief Resolved Unexplained Event (BRUE) in a 5-month-old female with extreme prematurity history (born at 25-26 weeks), a comprehensive workup is essential, including a complete history and physical examination, immediate diagnostic testing, and consideration of specialized tests and consultation with specialists 1. The workup should focus on potential causes like gastroesophageal reflux, seizures, or respiratory issues common in premature infants. Immediate diagnostic testing should include:
- Complete blood count
- Comprehensive metabolic panel
- Blood glucose
- Arterial blood gases
- Chest X-ray
- Electrocardiogram Additional testing should include:
- Continuous cardiorespiratory monitoring for 24-48 hours
- Electroencephalogram to rule out seizures
- Polysomnography to assess for apnea Consider specialized tests like:
- Video fluoroscopic swallow study
- pH probe monitoring for reflux
- Brain MRI to evaluate for neurological abnormalities Consultation with specialists including neonatology, neurology, pulmonology, and cardiology is recommended. This extensive workup is justified because premature infants, especially those born before 28 weeks, have higher risks of apnea, respiratory complications, neurological issues, and cardiac abnormalities that may contribute to BRUE, as noted in the American Academy of Pediatrics guidelines 1. Hospital admission is necessary for this high-risk patient to ensure close monitoring and comprehensive evaluation, as the risk of recurrent events or undiagnosed serious conditions is higher in this population 1.
From the Research
Brief Resolved Unexplained Events (BRUE) in High-Risk Infants
- A BRUE is defined as an event that occurs in an infant younger than 1 year, is unexplained, and resolves within a short period, typically less than 1 minute 2.
- The American Academy of Pediatrics (AAP) has established criteria for the diagnosis and management of BRUE, including guidelines for risk stratification and evaluation 2.
Risk Stratification for BRUE
- Infants with a history of extreme prematurity, such as the 5-month-old female in question, may be at higher risk for underlying conditions that could contribute to a BRUE 3, 4.
- The AAP guidelines recommend considering the infant's medical history, family history, and physical examination when determining the risk for a serious underlying disorder 2.
Evaluation and Management of High-Risk BRUE
- For high-risk infants, such as those with a history of extreme prematurity, a more comprehensive evaluation may be necessary, including laboratory tests, imaging studies, and consultation with specialists 2.
- The management of BRUE in high-risk infants should be individualized, taking into account the infant's specific medical history and risk factors 2.
Considerations for Infants with Extreme Prematurity
- Infants born extremely preterm, such as at 25-26 weeks of gestation, are at increased risk for neurodevelopmental disorders, respiratory illness, and other complications 3, 4.
- The evaluation and management of BRUE in these infants should consider their unique medical history and risk factors, and may require a more comprehensive and multidisciplinary approach 3, 4.