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Clinic Core. Original Papers

Episode apparently lethal (ALTE) concept has been recently modified by the American Academy of Pediatrics by the current brief resolved unexplained event (BRUE), in relation to acute events in infants. Comments concerning of an experience of five years in monitoring cardiorespiratory home


Zafra Anta MAa, Alonso de la Hoz Jb, Fernández Manso Bc, Nieto Gabucio Nd

aServicio de Pediatría. Hospital Universitario de Fuenlabrada. Fuenlabrada, Madrid. España.
bMIR-Pediatría. Hospital Universitario de Fuenlabrada. Fuenlabrada, Madrid. España.
cMIR-Pediatría. Hospital Universitario de Fuenlabrada. Fuenlabrada, Madrid. España.
dServicio de Pediatría. Hospital Universitario de Fuenlabrada. Fuenlabrada, Madrid. España.

Correspondence: MA Zafra. Email:

Reference of this article.:

Zafra Anta MA, Alonso de la Hoz J, Fernández Manso B, Nieto Gabucio N. Reciente modificación de la Academia Americana de Pediatría del concepto episodio aparentemente letal (ALTE) por el actual evento breve resuelto inexplicado (BRUE). Comentarios a propósito de una experiencia de cinco años en monitorización cardiorrespiratoria domiciliaria. Rev Pediatr Aten Primaria. 2017;19:23-8.

Published in Internet: 15/02/2017


Infants who present with a history of an acute event (an unexpected change in breathing, appearance, or behavior) reported by their caregiver represent a heterogeneous group with diverse pathophysiology. In the past, these events were termed apparent life-threatening events (ALTE). The American Academy of Pediatrics (AAP) recommends the replacement of the term ALTE with a new term: brief resolved unexplained event (BRUE). It provides an approach to patient evaluation, and management recommendations.

Objective: to describe the clinical characteristics and the evolution of patients enrolled in a CRD monitoring program in a second level hospital. We assess this work according to the new guide from the AAP.

Methods: retrospective study of all patients with indication of monitoring CRD, enrolled in a secondary level hospital, in Pediatric Neumology consultation (2010-2014). Database: Excel 2010®.

Results: seven patients were monitored (7/10,000 born), all males. The initial indication of monitoring CRD was: serious or recurrent ALTE (five cases), severe neonatal hypotonia (one case) and brother of sudden infant death (SID) (one case). The mean age of indication was 59.8 days.

Conclusions: we support the AAP proposition to use the term BRUE with or without risk factors, avoiding the name ALTE. Because of the diverse presentations, causes, risk factors, and prognosis of infants presenting with acute events, evaluation and management should be individualized. Most of the patients in which monitoring CRD is indicated may have tracking in a second level hospital. Long-term follow-up programs of infants with a BRUE-ALTE could contribute to adapt the healthcare activities to the needs of each patient and confirm the medical diagnosis.

Keywords: Ambulatoty monitoring. Sudden infant death. Infantile apparent life-threatening event.



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ISSN 2174-4106  Publicación Open Acess, incluida en DOAJ, sin cargo por publicación.

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