Long-Term Follow-Up of Infants After a Brief Resolved Unexplained Event–Related Hospitalization

Abstract

Objective A brief resolved unexplained event (BRUE) in infancy is a common reason for visiting the emergency department. However, little is known about the long-term outcomes of such an event. This study evaluates future mortality, morbidity, and/or developmental outcome after a BRUE. Methods A single-center retrospective study performed in 2009 to 2013 included 87 hospitalized infants (<1 year old) fitting the American Academy of Pediatrics' criteria of a lower-risk BRUE, with 2 exceptions: no time limit to duration of episode and no age limit of ≥60 days. Hospitalized infants were followed up for up to 5 years via a telephone questionnaire to assess mortality rates, developmental delay, neurological/cardiovascular morbidity, and future hospitalizations. Results Most infants (94%) who experienced a BRUE were hospitalized before 6 months of age. No cases of mortality occurred. In terms of developmental outcome, 1 child (1.15%) was diagnosed as having a global developmental delay and 12 (13.7%) with a language delay, similar to prevalence rates by age in the United States. Three children (3.4%) were diagnosed as having an autism spectrum disorder, with higher prevalence rates than the global average. Simple febrile and nonfebrile seizures were seen at a rate similar to the general population. None of the children developed cardiovascular disease. Rehospitalization occurred in 22% of cases: 90% for common acute pediatric causes and 10% for recurrent choking events secondary to gastroesophageal reflux disease. Conclusions Low-risk hospitalized infants younger than 1 year who experienced a BRUE seem to generally have an excellent prognosis.

Explanatory Diagnoses Following Hospitalization for a Brief Resolved Unexplained Event

“…12 In another study in which researchers managed infants hospitalized with a BRUE for 5 years, excellent longterm prognosis was observed. 13 Our findings add to the evidence that most patients with a BRUE do not receive a serious explanatory diagnosis, despite high rates of diagnostic testing and consultation to identify a cause for the event.…”

The Role of Combined Multichannel Intraluminal Impedance-pH Monitoring in Infants with Brief, Resolved, Unexplained Events

“…The latter is in line with the results of our study, since we showed that infants with BRUE have a good prognosis. Moreover, Ari et al [ 29 ] reported a retrospective study of 87 hospitalized infants younger than 1 year who experienced BRUE and concluded that infants hospitalized because of a BRUE seem to have a generally excellent prognosis. It seems that food thickeners treat visible regurgitation/vomiting in infants with GERD; however, their effect on overall GER episodes remains controversial [ 19 ].…”

Clinical Utility and Patient Distribution of Brief Resolved Unexplained Event Classification for Apparent Life-Threatening Events

“…A single-center retrospective study of 87 inpatient children diagnosed with lower-risk BRUE in Israel revealed no deaths after 5 years of follow-up. 13 Of the 87 patients, global developmental delay, retarded speech development, and convulsions were observed in 1 (1.15%), 12 (13.7%), and 3 (3.45%) patients, respectively; however, the respective prevalence rates of these conditions were the same as those of the given age group. In another single-center retrospective study of 762 patients diagnosed with ALTE in the United States, adverse outcomes were defined as the presence of recurrence, aspiration, trauma, and death and were observed in 40 (9%) of 436 patients with ALTE-not-BRUE, 23 (9%) of 256 patients with higher-risk BRUE, and 2 (2.9%) of 70 patients with lower-risk BRUE.…”

“…In this study, although no adverse outcomes were observed in cases classified as lower-risk BRUE, there were only a few such cases. A single-center retrospective study of 87 inpatient children diagnosed with lower-risk BRUE in Israel revealed no deaths after 5 years of follow-up 13 . Of the 87 patients, global developmental delay, retarded speech development, and convulsions were observed in 1 (1.15%), 12 (13.7%), and 3 (3.45%) patients, respectively; however, the respective prevalence rates of these conditions were the same as those of the given age group.…”