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Understanding BRUE in Infants: Diagnosis and Management


Core Concepts
BRUE diagnosis and management in infants involves careful assessment and shared decision-making.
Abstract
The content discusses the evolution of terminology from apnea episodes to BRUE in infants, highlighting the challenges in defining and managing these events. It emphasizes the importance of shared decision-making and the limited utility of extensive testing in identifying underlying conditions. Key points include: Historical evolution of terminology from apnea episodes to BRUE. Criteria for defining a BRUE episode in infants. Challenges in determining recurrence risk and the need for hospitalization. Development of BRUE 2.0 criteria for focused risk assessment. Red flags indicating the need for further evaluation. Recommendations for neurological and GI evaluations. Emphasis on shared decision-making with families.
Stats
"In 2013, authors of a systematic review coined the term 'brief resolved unexplained event' (BRUE)." "A BRUE recurred in 14.3% of the cohort, and 4.8% of high-risk infants were found to have a serious undiagnosed condition." "Data from 2023 demonstrate that only 1.1% of lab tests following a BRUE contributed to a diagnosis."
Quotes
"As I reflect back on two and a half decades of caring for these patients, I believe that recent data have helped us a great deal." "Nevertheless, looking for a few red flags, having a high index of suspicion when the clinical exam is abnormal, and engaging in shared decision-making with families can help make the caring for these challenging patients more bearable and lead to better outcomes for all involved."

Key Insights Distilled From

by William T. B... at www.medscape.com 02-12-2024

https://www.medscape.com/viewarticle/1000095
When Babies 'Stop Breathing,' Who Needs Admission, Workup?

Deeper Inquiries

How can shared decision-making impact the outcomes of infants with BRUE?

Shared decision-making can have a significant impact on the outcomes of infants with BRUE by involving families in the decision-making process regarding further testing and management. By engaging in shared decision-making, healthcare providers can better understand the preferences and values of the families, leading to more personalized care plans. This approach can help alleviate anxiety and uncertainty for families, improve adherence to treatment plans, and ultimately enhance the overall experience of care for both the families and the infants. Additionally, shared decision-making can promote a collaborative relationship between healthcare providers and families, fostering trust and mutual respect, which are essential for optimal outcomes in managing BRUE episodes.

What are the limitations of extensive testing in identifying underlying conditions in infants?

Extensive testing in infants with BRUE episodes may have limitations in identifying underlying conditions due to several factors. Firstly, many of these episodes are transient and self-resolving, making it challenging to capture the exact cause during testing. Additionally, the vast array of potential underlying conditions, ranging from seizures to airway anomalies, can make it difficult to pinpoint the specific diagnosis through testing alone. Moreover, the low yield of diagnostic tests following BRUE episodes, as evidenced by data showing that only a small percentage of lab tests and imaging studies contribute to a diagnosis, highlights the limited effectiveness of extensive testing in this context. Over-reliance on testing may lead to unnecessary procedures, increased healthcare costs, and potential harm to the infants without significantly improving diagnostic accuracy.

How can the healthcare system better support families in managing BRUE episodes?

The healthcare system can better support families in managing BRUE episodes by adopting a patient-centered approach that prioritizes communication, education, and shared decision-making. Providing families with clear and accurate information about BRUE, including the definition, common symptoms, and potential outcomes, can help alleviate anxiety and empower them to make informed decisions about their child's care. Healthcare providers should engage in open and honest discussions with families, actively listening to their concerns and preferences, and involving them in the decision-making process. Offering resources such as support groups, educational materials, and access to mental health services can further support families in coping with the stress and uncertainty associated with BRUE episodes. By fostering a collaborative and supportive environment, the healthcare system can enhance the overall experience of care for families managing BRUE episodes.
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