A 4-month-old baby boy was being rushed to your Emergency Department.

Mother noticed that her

baby suffered from apnoea. This was 1st time. When she tried to carry him, he regained spontaneous
breathing and returned to normal. She was worried with her baby’s condition.

1. Define Apparent Life-Threatening Event (ALTE). (3 marks)

• An episode that is frightening to the observer
• Characterised by some combination of (a change in):
1. Apnoea
2. Colour
3. Tone
4. Choking | Gagging
• Observer fears that infant has died

2. Define Brief, Resolved Unexplained Events (BRUE). (3 marks)

• Event in an infant <1 year of age
• Sudden & brief <1 minute (typically 20-30 seconds)
• A resolved episode of ≥1:
a. Absent, decreased or irregular breathing - Apnoea
b. Central cyanosis or pallor – Look different
c. Hypertonia | Hypotonia – Tone different
d. Altered level of responsiveness – Exhibit unconsciousness
• Diagnosis of exclusion
• Diagnosis by attending physician

3. Is this baby low risk or high risk? Please list down 4 criteria of low risk infants. (3 marks)
a. Low Risk
b. Low Risk Infants
1. Age >60 days
2. Gestational age ≥32 weeks | Post-conceptional age ≥45 weeks
3. 1st time
4. Duration <1 minute
5. No CPR by trained medical professional
6. No concerning history | physical examination findings

4. Please outline the management of lower risk infants with BRUE. (3 marks)
i. Caregivers
• Educate regarding BRUE
• CPR Training
ii. Medical Practitioner
• Observe for 1-4 hours reasonably
• Serial exam | Continuous pulse oximetry | 12-lead ECG | Pertussis testing
• Avoid hospitalisation solely for cardiopulmonary monitoring
• Discharge home if family comfortable and possible review within 12-24 hours