{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T16:56:25Z","timestamp":1792688185663,"version":"4.5.0"},"reference-count":42,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,8,1]]},"abstract":"<jats:p>In 2016, the American Academy of Pediatrics published a clinical practice guideline that more specifically defined apparent life-threatening events as brief resolved unexplained events (BRUEs) and provided evidence-based recommendations for the evaluation of infants who meet lower-risk criteria for a subsequent event or serious underlying disorder. The clinical practice guideline did not provide recommendations for infants meeting higher-risk criteria, an important and common population of patients. Therefore, we propose a tiered approach for clinical evaluation and management of higher-risk infants who have experienced a BRUE. Because of a vast array of potential causes, the initial evaluation prioritizes the diagnosis of time-sensitive conditions for which delayed diagnosis or treatment could impact outcomes, such as child maltreatment, feeding problems, cardiac arrhythmias, infections, and congenital abnormalities. The secondary evaluation addresses problems that are less sensitive to delayed diagnosis or treatment, such as dysphagia, intermittent partial airway obstruction, and epilepsy. The authors recommend a tailored, family-centered, multidisciplinary approach to evaluation and management of all higher-risk infants with a BRUE, whether accomplished during hospital admission or through coordinated outpatient care. The proposed framework was developed by using available evidence and expert consensus.<\/jats:p>","DOI":"10.1542\/peds.2018-4101","type":"journal-article","created":{"date-parts":[[2019,7,26]],"date-time":"2019-07-26T12:25:19Z","timestamp":1564143919000},"source":"Crossref","is-referenced-by-count":53,"title":["A Framework for Evaluation of the Higher-Risk Infant After a Brief Resolved Unexplained Event"],"prefix":"10.1542","volume":"144","author":[{"suffix":"II","given":"J. Lawrence","family":"Merritt","sequence":"first","affiliation":[{"name":"Department of Pediatrics, University of Washington and Seattle Children\u2019s Hospital, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo A.","family":"Quinonez","sequence":"additional","affiliation":[{"name":"Section of Pediatric Hospital Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua L.","family":"Bonkowsky","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah;"},{"name":"Brain and Spine Center, Primary Children\u2019s Hospital, Salt Lake City, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wayne H.","family":"Franklin","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Stritch School of Medicine, Loyola University, Maywood, Illinois;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Gremse","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of South Alabama, Mobile, Alabama;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce E.","family":"Herman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carole","family":"Jenny","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Washington and Seattle Children\u2019s Hospital, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eliot S.","family":"Katz","sequence":"additional","affiliation":[{"name":"Department of Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonard R.","family":"Krilov","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, New York University Winthrop, Mineola, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuck","family":"Norlin","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert E.","family":"Sapi\u00e9n","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Health Sciences Center, University of New Mexico, Albuquerque, New Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel S.","family":"Tieder","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Washington and Seattle Children\u2019s Hospital, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2019,8,1]]},"reference":[{"issue":"5","key":"2021120916231386700_B1","doi-asserted-by":"crossref","first-page":"e20160590","DOI":"10.1542\/peds.2016-0590","article-title":"Brief resolved unexplained events (formerly apparent life-threatening events) and evaluation of lower-risk infants [published correction appears in Pediatrics. 2016;138(2):e20161487].","volume":"137","author":"Tieder","year":"2016","journal-title":"Pediatrics"},{"issue":"1","key":"2021120916231386700_B2","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.jpeds.2012.12.086","article-title":"Management of apparent life-threatening events in infants: a systematic review.","volume":"163","author":"Tieder","year":"2013","journal-title":"J Pediatr"},{"key":"2021120916231386700_B3","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.chiabu.2017.04.033","article-title":"History, injury, and psychosocial risk factor commonalities among cases of fatal and near-fatal physical child abuse.","volume":"69","author":"Pierce","year":"2017","journal-title":"Child Abuse Negl"},{"issue":"1","key":"2021120916231386700_B4","doi-asserted-by":"crossref","first-page":"e20153756","DOI":"10.1542\/peds.2015-3756","article-title":"Validation of the pittsburgh infant brain injury score for abusive head trauma.","volume":"138","author":"Berger","year":"2016","journal-title":"Pediatrics"},{"issue":"2","key":"2021120916231386700_B5","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1097\/PEC.0b013e318280d663","article-title":"Subconjunctival hemorrhages in infants and children: a sign of nonaccidental trauma.","volume":"29","author":"DeRidder","year":"2013","journal-title":"Pediatr Emerg Care"},{"issue":"2","key":"2021120916231386700_B6","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1542\/peds.95.2.259","article-title":"Abusive head trauma: the relationship of perpetrators to their victims.","volume":"95","author":"Starling","year":"1995","journal-title":"Pediatrics"},{"key":"2021120916231386700_B7","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.chiabu.2018.03.020","article-title":"Are negative\/unrealistic parent descriptors of infant attributes associated with physical abuse?","volume":"80","author":"Young","year":"2018","journal-title":"Child Abuse Negl"},{"issue":"3","key":"2021120916231386700_B8","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1007\/BF01954386","article-title":"Lack of temporal relation between acid reflux in the proximal oesophagus and cardiorespiratory events in sleeping infants.","volume":"151","author":"Kahn","year":"1992","journal-title":"Eur J Pediatr"},{"key":"2021120916231386700_B9","doi-asserted-by":"crossref","first-page":"2050312117745221","DOI":"10.1177\/2050312117745221","article-title":"Correlation of Gastroesophageal reflux disease Assessment Symptom Questionnaire to impedance-pH measurements in children.","volume":"5","author":"Prachuapthunyachart","year":"2017","journal-title":"SAGE Open Med"},{"issue":"4","key":"2021120916231386700_B10","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1542\/peds.2004-0847","article-title":"Yield of diagnostic testing in infants who have had an apparent life-threatening event.","volume":"115","author":"Brand","year":"2005","journal-title":"Pediatrics"},{"issue":"2","key":"2021120916231386700_B11","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1542\/peds.2011-3084","article-title":"Patient- and family-centered care and the pediatrician\u2019s role.","volume":"129","author":"Committee on Hospital Care and Institute for Patient- and Family-Centered Care","year":"2012","journal-title":"Pediatrics"},{"issue":"2","key":"2021120916231386700_B12","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1007\/s10995-011-0751-7","article-title":"Family-centered care: current applications and future directions in pediatric health care.","volume":"16","author":"Kuo","year":"2012","journal-title":"Matern Child Health J"},{"issue":"4","key":"2021120916231386700_B13","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1542\/peds.2006-2549","article-title":"Do all infants with apparent life-threatening events need to be admitted?","volume":"119","author":"Claudius","year":"2007","journal-title":"Pediatrics"},{"issue":"7","key":"2021120916231386700_B14","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1097\/PEC.0b013e31825cf576","article-title":"A clinical decision rule to identify infants with apparent life-threatening event who can be safely discharged from the emergency department.","volume":"28","author":"Mittal","year":"2012","journal-title":"Pediatr Emerg Care"},{"issue":"4","key":"2021120916231386700_B15","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1016\/j.annemergmed.2012.08.035","article-title":"Apparent life-threatening event: multicenter prospective cohort study to develop a clinical decision rule for admission to the hospital.","volume":"61","author":"Kaji","year":"2013","journal-title":"Ann Emerg Med"},{"issue":"3","key":"2021120916231386700_B16","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1542\/pir.8-3-75","article-title":"Vulnerable child syndrome and its variants.","volume":"8","author":"Green","year":"1986","journal-title":"Pediatr Rev"},{"issue":"5","key":"2021120916231386700_B17","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1016\/j.jpeds.2010.04.072","article-title":"Abusive head trauma in children presenting with an apparent life-threatening event.","volume":"157","author":"Guenther","year":"2010","journal-title":"J Pediatr"},{"issue":"1","key":"2021120916231386700_B18","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1542\/peds.2007-3376","article-title":"Death, child abuse, and adverse neurological outcome of infants after an apparent life-threatening event.","volume":"122","author":"Bonkowsky","year":"2008","journal-title":"Pediatrics"},{"issue":"5","key":"2021120916231386700_B19","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1001\/archpedi.158.5.454","article-title":"Analysis of perpetrator admissions to inflicted traumatic brain injury in children.","volume":"158","author":"Starling","year":"2004","journal-title":"Arch Pediatr Adolesc Med"},{"issue":"11","key":"2021120916231386700_B20","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1136\/adc.2008.150110","article-title":"Which clinical features distinguish inflicted from non-inflicted brain injury? A systematic review.","volume":"94","author":"Maguire","year":"2009","journal-title":"Arch Dis Child"},{"issue":"7","key":"2021120916231386700_B21","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1001\/jama.281.7.621","article-title":"Analysis of missed cases of abusive head trauma.","volume":"281","author":"Jenny","year":"1999","journal-title":"JAMA"},{"key":"2021120916231386700_B22","volume-title":"Medical Child Abuse: Beyond Munchausen Syndrome by Proxy","author":"Roesler","year":"2009"},{"issue":"8","key":"2021120916231386700_B23","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1016\/j.jcfm.2006.10.004","article-title":"Pulmonary intra-alveolar hemorrhage in SIDS and suffocation.","volume":"14","author":"Krous","year":"2007","journal-title":"J Forensic Leg Med"},{"issue":"10","key":"2021120916231386700_B24","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1136\/adc.2009.170563","article-title":"The epidemiology of oro-nasal haemorrhage and suffocation in infants admitted to hospital in Scotland over 10 years.","volume":"95","author":"McIntosh","year":"2010","journal-title":"Arch Dis Child"},{"issue":"2","key":"2021120916231386700_B25","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1097\/MPG.0000000000001439","article-title":"Oropharyngeal dysphagia is strongly correlated with apparent life-threatening events.","volume":"65","author":"Duncan","year":"2017","journal-title":"J Pediatr Gastroenterol Nutr"},{"issue":"5","key":"2021120916231386700_B26","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1177\/000992289803700505","article-title":"Characterization of failure to imbibe in infants.","volume":"37","author":"Gremse","year":"1998","journal-title":"Clin Pediatr (Phila)"},{"issue":"3","key":"2021120916231386700_B27","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1016\/j.jpeds.2008.08.051","article-title":"Risk factors for extreme events in infants hospitalized for apparent life-threatening events.","volume":"154","author":"Al-Kindy","year":"2009","journal-title":"J Pediatr"},{"issue":"10","key":"2021120916231386700_B28","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1197\/j.aem.2005.06.003","article-title":"Prevalence of anemia in children presenting with apparent life-threatening events.","volume":"12","author":"Pitetti","year":"2005","journal-title":"Acad Emerg Med"},{"issue":"12","key":"2021120916231386700_B29","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1136\/archdischild-2012-301668","article-title":"Cardiac testing and outcomes in infants after an apparent life-threatening event.","volume":"97","author":"Hoki","year":"2012","journal-title":"Arch Dis Child"},{"issue":"5","key":"2021120916231386700_B30","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1016\/j.jpeds.2013.12.027","article-title":"Should infants presenting with an apparent life-threatening event undergo evaluation for serious bacterial infections and respiratory pathogens?","volume":"164","author":"Claudius","year":"2014","journal-title":"J Pediatr"},{"issue":"4","key":"2021120916231386700_B31","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1177\/0009922807310934","article-title":"Infections and apparent life-threatening events.","volume":"47","author":"Altman","year":"2008","journal-title":"Clin Pediatr (Phila)"},{"issue":"3","key":"2021120916231386700_B32","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1001\/archpedi.1984.02140410027010","article-title":"Respiratory syncytial virus-related apnea in infants. Demographics and outcome.","volume":"138","author":"Church","year":"1984","journal-title":"Am J Dis Child"},{"issue":"11","key":"2021120916231386700_B33","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1136\/adc.2003.031740","article-title":"Causes of apparent life threatening events in infants: a systematic review.","volume":"89","author":"McGovern","year":"2004","journal-title":"Arch Dis Child"},{"issue":"1","key":"2021120916231386700_B34","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1136\/emj.19.1.11","article-title":"Apparent life threatening events in infants presenting to an emergency department.","volume":"19","author":"Davies","year":"2002","journal-title":"Emerg Med J"},{"issue":"2","key":"2021120916231386700_B35","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1007\/s00431-003-1365-x","article-title":"Recommended clinical evaluation of infants with an apparent life-threatening event. Consensus document of the European Society for the Study and Prevention of Infant Death, 2003.","volume":"163","author":"Kahn","year":"2004","journal-title":"Eur J Pediatr"},{"issue":"3","key":"2021120916231386700_B36","first-page":"154","article-title":"How to evaluate the child presenting with an apparent life-threatening event?","volume":"12","author":"Weiss","year":"2010","journal-title":"Isr Med Assoc J"},{"issue":"3","key":"2021120916231386700_B37","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1097\/00005176-199104000-00005","article-title":"Gastroesophageal reflux in infants with a history of near-miss sudden infant death.","volume":"12","author":"Veereman-Wauters","year":"1991","journal-title":"J Pediatr Gastroenterol Nutr"},{"issue":"3","key":"2021120916231386700_B38","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1136\/adc.2004.049452","article-title":"Epidemiology of apparent life threatening events.","volume":"90","author":"Kiechl-Kohlendorfer","year":"2005","journal-title":"Arch Dis Child"},{"issue":"3","key":"2021120916231386700_B39","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1016\/S0022-3476(05)81747-0","article-title":"Recurrent apparent life-threatening events during infancy: a manifestation of inborn errors of metabolism.","volume":"123","author":"Arens","year":"1993","journal-title":"J Pediatr"},{"issue":"5","key":"2021120916231386700_B40","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1007\/BF01956418","article-title":"Medium-chain acyl-CoA dehydrogenase deficiency does not correlate with apparent life-threatening events and the sudden infant death syndrome: results from phenylpropionate loading tests and DNA analysis.","volume":"153","author":"Penzien","year":"1994","journal-title":"Eur J Pediatr"},{"issue":"3","key":"2021120916231386700_B41","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1016\/j.jpeds.2009.10.031","article-title":"Very long-chain acyl-CoA dehydrogenase deficiency in a patient with normal newborn screening by tandem mass spectrometry.","volume":"156","author":"Ficicioglu","year":"2010","journal-title":"J Pediatr"},{"issue":"5","key":"2021120916231386700_B42","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1542\/peds.2014-1778","article-title":"Overdiagnosis: how our compulsion for diagnosis may be harming children.","volume":"134","author":"Coon","year":"2014","journal-title":"Pediatrics"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2018-4101\/1077936\/peds_20184101.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2018-4101\/1077936\/peds_20184101.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,24]],"date-time":"2022-09-24T17:38:16Z","timestamp":1664041096000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/144\/2\/e20184101\/38550\/A-Framework-for-Evaluation-of-the-Higher-Risk"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8,1]]},"references-count":42,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2019,8,1]]},"published-print":{"date-parts":[[2019,8,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2018-4101","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,8,1]]},"article-number":"e20184101"}}