Introduction:
ALTE (apparent life-threatening event) and BRUE (brief, resolved, unexplained event) are types of disorders that occur in infants at an earlier stage. It occurs in babies less than a year old. The incidence rate of ALTE and BRUE is very high. It occurs once in ten to 12 weeks. Initially, it was called a life-threatening condition. Now the term is not used by the American Academy due to the intervention of treatment and life-saving procedures.
What Is BRUE?
A baby under a year old who stops breathing, exhibits an alteration in muscle tone, becomes pale or blue, or becomes unresponsive is considered to have had a short resolved unexplained episode (BRUE). The person tending to the infant has a quick and terrifying incident that lasts for less than 30 to 60 seconds (BRUE baby).
Only after a complete history and examination is BRUE present and no plausible explanation for the incident can be found. An apparent life-threatening event (ALTE) is an earlier term for these kinds of incidents.
What Are the Causes of ALTE and BRUE?
The causes of ALTE and BRUE are explained below:
Laryngospasm - It causes swallowing difficulty and gastroesophageal reflux disease (GERD). This eventually results in BRUE.
Neurologic Disorders - Seizures or severe neurologic disorders cause breath-holding during sleep due to unexplained events. This is known as obstructive sleep apnea.
Abnormalities in The Brain - Malformations in the brain or brain tumors affect the breathing mechanism.
Respiratory Syncytial Virus - Frequent pertussis or cough impacts the respiratory tract and breathing process.
Infections - Sepsis and meningitis.
How Is BRUE Classified?
Based on their history, they are classified as low-risk and high-risk.
Low-Risk Infants:
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Infants of age more than 60 days.
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Gestation age of more than 34 weeks.
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Single event. No history of multiple BRUE.
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No history of CPR (cardiopulmonary resuscitation) during BRUE.
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No family history of ALTE and BRUE.
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Physical examination appears normal in infants (afebrile).
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No underlying systemic conditions.
High-Risk Infants: Apart from the conditions mentioned in the low-risk category, other conditions refer to high-risk. These infants are carefully evaluated to avoid misinterpretation.
What Are the Symptoms of ALTE and BRUE?
The following symptoms can be looked for ALTE and BRUE-
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The infant has sleep-disordered breathing, known as sleep apnea. It most commonly occurs in premature babies.
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The color of the baby changes due to a lack of oxygen. This is termed cyanosis.
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Irregular breathing lasts for a minute. There may be decreased breathing.
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There is an altered and poor response to hunger and sleep.
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Complete transition in the muscle tone. It becomes weak and gives the appearance of an unhealthy child.
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Increased signs of distress.
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Frequent coughing and the infants become febrile.
How Are ALTE and BRUE Evaluated?
The doctor will question the caretaker regarding the following:
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Noises made by the child, color change, and muscle tone.
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Actions like CPR (cardiopulmonary resuscitation) were done or not.
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Information about the perinatal complications.
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Feeding habits like gagging reflex and information about weight loss.
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History of recent illness or trauma in infants.
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History of similar events in the family members.
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Physical examination of vital signs, posture, signs of infection, respiratory signs, and signs of abuse are assessed.
What Are the Various Diagnostic Methods to Diagnose ALTE and BRUE?
According to the guidelines given by the American Academy, minimal testing can be done in infants with low risk. Imaging studies, blood tests, or routine checkups are not mandatory in low-risk infants.
Swab Test - A sample is collected when the infant coughs. It is examined in the culture test for the presence of respiratory illnesses.
ECG (Electrocardiography) - The heart condition is analyzed using ECG. Only 12 leads are used in infants. Underlying ailments related to cardiac systems can be interpreted using ECG.
Pulse Oximetry - If the caregivers become anxious and are not aware of emergency procedures like CPR, the infants should at least be monitored using pulse oximetry. They should be admitted within 24 hours.
Careful attention should be given to high-risk infants by caregivers. They are diagnosed by the following tests;
Blood Test - Blood samples are obtained from infants. It is examined in the laboratory. It is used to diagnose the presence of respiratory infections.
Chest X-rays - Other imaging tests are difficult to obtain in infants due to age factors. Hence, only chest X-rays are taken. The development or abnormalities of the lungs and heart are carefully observed in the radiographic images. Changes in the rib formation, bronchi, or lungs are interpreted using X-rays.
How Should a Caretaker Manage the Infants Suffering From ALTE and BRUE?
The medical professional identifies the cause of ALTE and BRUE. Management of the cause can prevent major ailments. Home monitoring devices are prescribed for the caretakers to prevent acute attacks in infants. Infants with high risk require regular follow-ups with specialists like cardiologists, pediatricians, and neurologists.
Low-Risk Infants: Caregivers are trained to provide safe infant care at home as a first aid measure. Then the infants must be reevaluated in the emergency room within 24 hours after the inspection of any major events.
High-Risk Infants: Apnea-controlling devices are prescribed for high-risk infants. Their caretakers are instructed to use the device at home for a specific period. Home monitoring is essential to reduce the incidence of mortality rate. Exposure to severe irritants, tobacco smoke, and pollutants must be avoided. The caretaker should keep the infant in a well-ventilated area away from exposure. The environment should be safe and harmless for infants. The transient and alarming events in high-risk infants require immediate medical attention. Physical abuse by the caretaker should be strictly monitored by the healthcare professional in the long term.
What Is the Prognosis of an Infant With ALTE and BRUE?
The prognosis of infants with low-risk disorders is better and with high-risk disorders depends on the cause. Increased risks are associated with infants suffering from neurological disorders or brain tumors. Though ALTE does not cause long-term side effects by itself, its associated disorders, like cardiac or neurologic manifestations, may cause fatal outcomes.
Conclusion:
Some systemic conditions associated with ALTE and BRUE improve to normal conditions after a few years. Hence, the recurrence rate is very low. Some of the conditions do not develop any complications in infants and subside in the future. BRUE is more harmless when compared to ALTE as it does not cause sudden infant death syndrome. Studies have revealed that infants affected by sudden infant death syndrome do not suffer from prior events. An infant with a history of two or more events dies because of sudden infant death syndrome. It happens in ten percent of cases with ALTE and BRUE.
