This transcript has been edited for clarity.
Justin L. Berk, MD, MPH, MBA: Welcome backmost to the Cribsiders. This is simply a Medscape video recap summary of 1 of our astir caller podcast episodes.
Jessica Hane, MD, MPH, MBA: For those of you who don't cognize us, we are the pediatric medicine podcast. We interrogation starring experts successful the tract to bring objective pearls, signifier changing knowledge, and reply lingering questions astir halfway topics successful pediatric medicine.
Berk: All right, Jessica, what taxable are we reviewing today?
Hane: We are present contiguous to speech astir the important pediatric taxable of little resolved unexplained events (BRUE), "BRUE's Clues: Understanding Brief Resolved Unexplained Events with Dr. Tieder." We chatted with Dr Tieder, who is simply a pediatric hospitalist and subordinate prof astatine Seattle Children's Hospital astatine the University of Washington, and, astir importantly, a starring adept successful little resolved unexplained events. In today's recap, we volition speech astir definitions, however to risk-stratify patients, and stock immoderate objective pearls from Dr Tieder.
Berk: So archetypal and possibly astir important, I loved it erstwhile it was called ALT. It was truthful overmuch easier to say. Is BRUE pronounced brew? Is it brewie? How bash we speech astir these patients?
Hane: That's a large question and 1 that we got to the bottommost of connected the amusement with Dr Tieder. The subcommittee determined that it is pronounced brew similar acold brew truthful arsenic not to beryllium confused with the already existing aesculapian word bruit.
Berk: That's truly helpful. I've been saying it wrong. What is simply a little resolved unexplained event?
Hane: A BRUE is defined arsenic an lawsuit occurring successful an babe little than 1 twelvemonth of age. It's erstwhile the genitor oregon perceiver reports a abrupt little (less than 1 minute) and present resolved lawsuit that has 1 oregon much of the pursuing characteristics:
Change successful color; this tin beryllium cardinal cyanosis oregon pallor
Change successful breathing pattern, specified arsenic absent, decreased, oregon irregular breathing
Change successful code (hyper- oregon hypotonic)
Change successful responsiveness
It is important to retrieve that determination should beryllium nary mentation for the event. If determination is an explicit explanation, it would beryllium called a little resolved explained lawsuit (BREE).
Berk: I loved learning astir the word BREE successful this episode. One of the large topics that comes up with a diligent with a BRUE is making these patients debased hazard oregon risk-stratifying them. What makes a diligent debased risk?
Hane: Dr Tieder taught america astir each the criteria that request to beryllium met for an babe to beryllium considered debased risk. First of all, they request to beryllium older than 60 days of age. The gestational property should beryllium much than 32 weeks, and post-conceptional property should beryllium much than 45 weeks. This needs to beryllium the child's archetypal existent event. The duration should beryllium little than a minute. No medically trained providers should person fixed CPR during the event. And finally, and astir apt astir important, determination should beryllium nary concerning features connected past oregon connected the carnal exam. Some examples would beryllium bruising erstwhile you bash the carnal exam oregon a household past of thing similar cardiac arrhythmias.
Berk: What astir the higher hazard category? What bash we bash with these higher hazard patients?
Hane: Basically, immoderate kid who does not conscionable the little hazard class is automatically successful the higher hazard category. One happening that I thought was truly large was that Dr Tieder pointed retired that these patients are not truly high risk, they are conscionable higher hazard than the debased hazard radical successful general. He did not urge broad investigating for these infants. That is not utile oregon recommended, and there's truly nary 1 trial that everyone successful the higher hazard radical needs to get. Depending connected the objective past and exam, respective things to see for the higher hazard patients would beryllium a 4-hour cardiorespiratory monitoring test, a swallow evaluation, oregon possibly an ear, nose, and pharynx (ENT) consult if the objective past suggests a occupation there. And past yet adjacent outpatient follow-up.
Berk: This is truly helpful. Were determination immoderate different pearls that came from the occurrence that you remember?
Hane: Yes. So 1 happening that I thought was cardinal was that 96% of BRUEs are self-resolved and aren't recovered to person an underlying etiology. So basically, we should beryllium truly cautious astir doing broad evaluations and beryllium truly intentional with our workup. Most kids don't truly request immoderate workup. If you tin explicate the lawsuit specified as, you know, possibly a seizure oregon gastroesophageal reflux, it is not a BRUE, it's a BREE. And therefore, this model we're talking astir contiguous doesn't truly apply. And past the last happening we learned is that determination are immoderate caller guidelines successful the works for BRUEs. So enactment tuned.
Berk: Great. This was a large recap of BRUE and BREE. Thanks for joining america for this Medscape video recap of the Cribsiders pediatric podcast. To perceive to this afloat episode, click connected "BRUE's Clues: Understanding Brief Resolved Unexplained Events with Dr. Tieder" oregon look for it connected immoderate podcast player. Thanks for tuning in.
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