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Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!
You are seeing a 29 day old afebrile former 35 weeker brought in by ambulance. The patient was given a few sips of “gripe water” for runny nose, appeared to choke and gasp for air, turned blue briefly, then recovered. The entire episode was about a minute. There was no tone change. The baby has no birth complications. The baby’s vital signs and physical exam are normal in the ED, pulse ox is 100% on room air, RSV testing is negative. What would be your management?
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March 4, 2019 at 9:15 pm
The AAP guidelines on managing BRUE (Brief Resolved Unexplained Events) state that low risk BRUEs meet the following: patient age > 60 days, born at > 32 weeks and corrected gestational age > 45 weeks, no CPR by trained medical provider, event lasted < 1 minute, first event. This patient does not meet low risk criteria. However, BRUE by definition is unexplained, and there is an explanation in the choking episode for this patient’s event. The AAP BRUE guidelines state that if there is an explanation for the event, it is not a BRUE, and the guidelines then do not offer management guidance.