A brief resolved unexplained event (BRUE) is a sudden episode in an infant under 1 year that lasts under 1 minute and fully resolves, such as a change in breathing, color, tone or responsiveness. By definition no cause is found after a careful history and exam, and low-risk infants usually need little testing.
Key symptoms
- Pale or blue color during the event
- Absent, slowed or irregular breathing
- Sudden floppiness or stiffness
- Not responding for a short time
- Infant back to normal when help arrives
What you find on exam
- Full set of vital signs, including oxygen saturation
- Pediatric assessment triangle: appearance, work of breathing, circulation to skin
- Head-to-toe exam for bruises, head swelling or other signs of abuse
- Signs of infection, dehydration or breathing problems
- Feeding history, reflux, choking and family history of sudden death
Tests
- Low-risk infants: often a short period of pulse oximetry monitoring and possibly an ECG
- Higher-risk infants: tests based on findings, such as blood count, glucose and cultures
- Consider evaluation for abuse if any history or exam concern
Treatment basics
- Support airway and breathing if the infant is not fully back to normal
- Transport for evaluation, even if the infant now looks well
- Low risk: older than 60 days, born at 32 weeks or later, first event, under 1 minute, no CPR by trained provider
- Higher risk: observation and further workup in the hospital
- Teach caregivers infant CPR and safe sleep
Red flags
- Event that lasted over 1 minute or needed CPR
- Infant not back to baseline, or abnormal vital signs
- Signs of injury or a history that does not fit
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Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; NCSBN 2026 NCLEX-RN Test Plan; National EMS Education Standards (2021). Written by Making Synapses. Making Synapses is not affiliated with these organizations.