Management of brief resolved unexplained events (BRUE) in infants: a practice point for evidence-based practice and family-centred care

In 2016, the American Academy of Pediatrics (AAP) defined “brief resolved unexplained events” (BRUE) as brief, sudden, spontaneously resolving episodes in infants younger than 1 year of age, characterized by a change in colour, breathing, muscle tone, or responsiveness, and unexplained after focused clinical evaluation. BRUE replaced a broader, less specific term: “apparent life-threatening events” (ALTE). An AAP guideline offered risk-based recommendations grounded in older ALTE literature. A more precise BRUE definition has since improved understanding of outcomes and management. BRUE-related publications from 2016 to 2025 were systematically reviewed for this practice point, and evidence from 24 eligible studies has been summarized to produce the ‘best practice’ points offered here. Serious diagnoses are rare, mortality is comparable to that in the general population, and most well-appearing infants can be safely managed without hospital admission. This practice point emphasizes the importance of a careful history and physical examination to exclude alternative diagnoses and recommends against routine testing unless clinically indicated because overtesting can lead to false positives and unnecessary interventions.