Framework for evaluation after a brief resolved unexplained event (BRUE) for an infant who does not meet low-risk criteria

BRUE: brief resolved unexplained event; CBC: complete blood count; RSV: respiratory syncytial virus; CNS: central nervous system; CPR: cardiopulmonary resuscitation.
* Concerning historical features include social risk factors for child abuse, respiratory illness or exposure, recent injury, other symptoms in days preceding the event (fever, fussiness, diarrhea, or decreased intake), administration or access to medications, history of episodic vomiting or lethargy, developmental delay or congenital anomalies, and family history of BRUE or sudden unexplained death in a sibling.
¶ Concerning physical examination findings include any signs of injury, including bleeding, bruising (especially on the scalp, trunk, face, or ears), torn frenulum, or bulging anterior fontanel; altered sensorium; fever or toxic appearance; respiratory distress; abdominal distension or vomiting; heart murmur or gallop; decreased pulses, hepatomegaly or splenomegaly.
Δ Test for pertussis if the infant has suggestive symptoms, has not been completely immunized, and/or has been exposed in an endemic region or outbreak.
◊ The extent of the evaluation for child maltreatment and feeding disorder is guided by level of concern from history and physical findings.
§ The evaluation for toxic ingestion should include a focused history and laboratory screening to detect accidental or intentional ingestions of poisons or medications, including over-the-counter cold preparations and ethanol.