It’s the scenario no parent ever wants to experience. A baby that’s been perfectly healthy seems to stop breathing for….what seems like forever. In addition, he looks a little blue. 911 is called; perhaps the parents know CPR and begin that activity. In any case, by the time emergency medical help arrives, the baby looks perfectly fine. He’s transferred to the hospital—probably one with a specialized pediatric unit.
Multiple tests fail to show anything wrong, and he continues to look healthy. The baby’s been sent home on a monitor. At home monitor goes off regularly, but the baby looks fine every time he’s checked. In fact, they’ve seen it go off when they’ve been looking right at the baby, who’s sleeping and breathing comfortably at the moment. In frustration, the parents take the monitor off.
Frustration is also the word that comes to mind to a busy pediatrician, who might have several sets of parents a year that go through something like this. There’s that feeling of not being able to give a family good answers and a nagging fear that something worse is imminent for the baby. It’s an incredibly uncomfortable topic, which likely explains why I see so few articles aimed at parents on the matter. And while anything your baby is doing that doesn’t seem right should be run by her provider, it’s helpful to know the basics regarding unexplained infant events and the most recent recommendations on their management.
Alphabet Soup: Knowing the Terms
You may have noticed that these days, very little about medicine can be written without using initials—lots of them. Our current subject is no exception, so, to paraphrase that often-heard telephone recording, please read closely as our initials have changed. We used to speak of an apparent life-threatening event (ALTE) when an infant did one or more of the following:
- Stopped breathing, or exhibited irregular breathing
- Changed color (usually blue or pale)
- Became less responsive
- Showed a change in muscle tone (stiff or limp)
Because recent thinking is that in an otherwise healthy infant, these events may be less likely to be life-threatening, the American Academy of Pediatrics (AAP) in 2016 proposed a new term for the same occurrence: brief resolved unexplained event (BRUE). It’s the same thing, but the new term has different implications.
We can’t leave our initials primer without talking about one set you might have heard of: sudden infant death syndrome (SIDS), which was sometimes called “crib death” in the past. This has in recent years been renamed to sudden unexplained infant death (SUID), emphasizing that fact that the cause of the baby’s death is unknown.
BRUE and SUID
Now that we know what stands for what, we can ask: Is BRUE related to SUID? While one can never determine which infants—with or without a BRUE—will go on to sudden death, the two appear to have little relation to each other—if the infant is otherwise healthy and was born at or close to term. (Premature infants merit a different discussion.)
What’s most important is that any infant who may have experienced a BRUE be evaluated right away by a pediatrician. The doctor will take a thorough history, including a family history of unexplained deaths, and do an examination. The goal here is to look for any risk factors for sudden infant death.
A prompt history and examination (including family history) have always been warranted in the case of such an event. Where the newer recommendations differ from the previous ones is what might be done if all is normal on that first evaluation. According to the AAP, not every baby in this category may need further testing; the risks of testing may outweigh the risks of SUID. It’s definitely a decision that needs to be made individually for every baby in every situation.
What About a Monitor?
Lots and lots of babies who go through a BRUE end up going home with a monitor. (We’re not talking about those things that sit on a table in baby’s room; we’re referring to devices that are placed directly on the baby and track breathing and heart rate.) Yet we’ve known for a long time that monitors have not been shown to prevent SUID in otherwise healthy infants with such events. While a lot of it is done for peace of mind, any parent who’s had a baby with one can attest to the disruptive false alarms. Some studies have shown that the monitor can actually increase parental anxiety.
At the end of the day, I can’t emphasize enough that what to do in the case of a BRUE needs to be discussed carefully with your little one’s provider. If you do commit to a monitor, it’s also important to have a discussion before you think about discontinuing it; your pediatrician may have had reasons for OK’ing it that make it desirable to continue. Meanwhile, it’s important to know a little about normal variations in baby breathing, and to also be aware of one thing you can do to protect against sudden infant death—put your baby on his back to sleep in a level crib with a firm mattress and no soft bedding or toys!