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Important areas for future prospective research include the following. Influence of race, gender, ethnicity, seasonality, environmental exposures, and socioeconomic status on incidence and outcomesPatient- and family-centered outcomes, including caregiver satisfaction, anxiety, and family dynamics (eg, risk of vulnerable child syndrome)Caregiver education strategies, including basic life support, family-centered education, and postpresentation clinical lists S.

All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of Triamcinolone Acetonide Injectable Suspension (Triesence)- Multum has neither solicited nor accepted any commercial involvement in the development of the content of this publication.

The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

All clinical practice guidelines from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

Skip to main content googletag. AAP Policy SupplementsSupplements Publish Supplement MultimediaVideo Abstracts Pediatrics On Call Podcast Subscribe Alerts Careers Discover Pediatric Novartis hellas on COVID-19 daptacel vaccine package insert Racism and Its Effects on Pediatric Health From the American Academy of PediatricsClinical Practice GuidelineJoel S.

Gremse, Bruce Herman, Eliot S. Lawrence Merritt, Chuck Radiogardase (Insoluble Prussian blue)- FDA, Jack Percelay, Robert E. Radiogardase (Insoluble Prussian blue)- FDA Practice Guideline: Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants. IntroductionThis clinical practice guideline applies to infants younger than 1 year and is intended for applied methods of research clinicians.

View this Radiogardase (Insoluble Prussian blue)- FDA inlineView popupTABLE 1 BRUE Definition and Factors for Inclusion and ExclusionBRUE DefinitionClinicians should use the term BRUE to describe an event occurring in an infant cyanosis or pallorabsent, decreased, or irregular breathingmarked change in tone Radiogardase (Insoluble Prussian blue)- FDA or hypotonia)altered level Radiogardase (Insoluble Prussian blue)- FDA responsivenessMoreover, clinicians should diagnose a BRUE only when there is no explanation for a qualifying event after conducting an appropriate history and physical examination (Tables 2 and 3).

View this table:View inlineView popupTABLE 2 Historical Features To Be Radiogardase (Insoluble Prussian blue)- FDA in the Evaluation of a Potential BRUEView this table:View inlineView popupTABLE 3 Physical Examination Features To Be Considered in the Evaluation of a Potential BRUERisk Assessment: Lower- Versus Higher-Risk BRUEPatients who have experienced a BRUE may have a recurrent event or an undiagnosed serious condition (eg, child abuse, pertussis, etc) that confers a risk of adverse outcomes.

Patient Factors That Determine Lower RiskTo be designated lower risk, the following criteria should be met (see Fig 1):Diagnosis, risk classification, and recommended management of a BRUE. MethodsIn July 2013, the American Academy of Pediatrics (AAP) convened a multidisciplinary subcommittee composed of primary care clinicians and experts in the fields of general pediatrics, hospital medicine, emergency medicine, infectious diseases, child abuse, sleep medicine, pulmonary medicine, cardiology, neurology, biochemical genetics, gastroenterology, environmental health, and quality improvement.

AAP rating of evidence and recommendations. View this table:View inlineView popupTABLE 4 Guideline Definitions for Key Action StatementsView this table:View inlineView popupTABLE 5 Summary of Key Action Statements for Lower-Risk BRUEsKey Action Statements for Lower-Risk BRUE1.

Clinicians May Briefly Monitor Infants Presenting With a Lower-Risk BRUE With Continuous Pulse Oximetry and Serial Observations (Grade D, Weak Recommendation)Aggregate Evidence QualityGrade DBenefitsIdentification of hypoxemiaRisks, harm, costIncreased costs due to monitoring over time and the use of hospital resourcesFalse-positive results may lead to subsequent testing and hospitalizationFalse reassurance from negative test resultsBenefit-harm assessmentThe potential benefit of detecting hypoxemia outweighs the harm of cost and false resultsIntentional vaguenessDuration of time to monitor patients with continuous pulse oximetry and the number and frequency of serial observations may varyRole of patient preferencesLevel of caregiver concern may influence the duration of oximetry monitoringExclusionsNoneStrengthWeak recommendation (based on low quality of evidence)Key references33,361C.

Clinicians May Obtain a 12-Lead Electrocardiogram for Infants Presenting With Lower-Risk BRUE (Grade C, Weak Recommendation)Aggregate Radiogardase (Insoluble Prussian blue)- FDA QualityGrade CBenefitsMay identify BRUE patients with channelopathies (long QT syndrome, short QT syndrome, and Brugada syndrome), ventricular pre-excitation (Wolff-Parkinson-White syndrome), cardiomyopathy, or other heart diseaseRisks, harm, costFalse-positive results may lead to further workup, expert consultation, anxiety, and costFalse reassurance from negative resultsCost and availability of electrocardiography testing and interpretationBenefit-harm assessmentThe benefit of identifying patients at risk of sudden cardiac death outweighs the risk of cost and Radiogardase (Insoluble Prussian blue)- FDA resultsIntentional vaguenessNoneRole of patient preferencesCaregiver may decide not to have testing performedExclusionsNoneStrengthWeak recommendation (because of equilibrium between benefits and harms)Key references4,161G.

Clinicians Need Not Obtain Neuroimaging (Computed Tomography, MRI, or Ultrasonography) To Detect Child Abuse in Infants Presenting With a Lower-Risk BRUE (Grade C, Weak Recommendation)Aggregate Evidence QualityGrade CBenefitsDecrease costAvoid sedation, radiation exposure, consequences of false-positive resultsRisks, harm, costMay miss cases of child abuse and potential subsequent harmBenefit-harm assessmentThe benefits of reducing unnecessary testing, sedation, radiation exposure, and false-positive results, as well as alleviating caregiver and infant anxiety, outweigh the rare missed diagnostic opportunity for child abuseIntentional vaguenessNoneRole of patient preferencesCaregiver concerns may lead to requests for CNS imagingExclusionsNoneStrengthWeak recommendation (based on low quality of evidence)Key references3,672B.

Clinicians Should Not Prescribe Antiepileptic Medications for Potential Neurologic Disorders in Infants Presenting With a Lower-Risk BRUE (Grade C, Radiogardase (Insoluble Prussian blue)- FDA Recommendation)Aggregate Evidence QualityGrade CBenefitsReduce medication adverse effects and risks, avoid treatment with unproven efficacy, and reduce costRisks, harm, costDelay in treatment of epilepsy could lead to subsequent BRUE or seizureBenefit-harm assessmentThe benefits of reducing medication stages of recovery from addiction effects, avoiding unnecessary treatment, and reducing cost outweigh the risk of delaying treatment of epilepsyIntentional vaguenessNoneRole of patient preferencesCaregivers may feel reassured by starting a medicine but may not understand the medication risksExclusionsNoneStrengthModerate recommendationKey references32,85,874.

Clinicians Should Not Prescribe Acid Suppression Therapy for Infants Presenting With a Lower-Risk BRUE (Grade C, Moderate Recommendation)Aggregate Evidence QualityGrade CBenefitsReduce unnecessary medication use, adverse effects, and cost from treatment with unproven efficacyRisks, harm, costDelay treatment of rare but undiagnosed gastrointestinal disease, which could lead to complications (eg, esophagitis)Benefit-harm assessmentThe benefits of reducing medication adverse effects, avoiding unnecessary treatment, and reducing cost outweigh the risk of delaying treatment of gastrointestinal diseaseIntentional vaguenessNoneRole of patient preferencesCaregiver concerns may lead to requests for treatmentExclusionsNoneStrengthModerate recommendationKey reference986.

Inborn Errors of Metabolism6A. Serum BicarbonateAbnormal serum bicarbonate levels have Radiogardase (Insoluble Prussian blue)- FDA studied in 11 infants, of whom 7 had a diagnosis of sepsis or seizures. Serum GlucoseAbnormal blood glucose levels were evaluated but not reported in 3 studies.

AmmoniaElevations of ammonia are typically associated with persistent symptoms and recurring events, and therefore testing would not be indicated in lower-risk BRUEs. Venous or Arterial Blood GasBlood gas abnormalities leading to a diagnosis have not been reported in previous ALTE studies. Urine Organic Acids, Plasma Amino Acids, Plasma AcylcarnitinesThe role Radiogardase (Insoluble Prussian blue)- FDA advanced screening for IEMs has been reported in only 1 publication.

Patient- and Family-Centered Care8A. Clinicians Should Offer Resources for CPR Training to Caregivers (Grade C, Moderate Recommendation)Aggregate Evidence QualityGrade CBenefitsDecrease caregiver anxiety and increase confidenceBenefit Radiogardase (Insoluble Prussian blue)- FDA societyRisks, harm, costMay increase caregiver anxietyCost and availability of trainingBenefit-harm assessmentThe benefits of decreased caregiver anxiety and increased confidence, as well as societal benefits, Radiogardase (Insoluble Prussian blue)- FDA the increase in caregiver anxiety, cost, and resourcesIntentional vaguenessNoneRole of patient preferencesCaregiver may decide not to seek out the trainingExclusionsNoneStrengthModerate recommendationKey reference1158B.

Clinicians Should Educate Caregivers About BRUEs (Grade Verelan (Verapamil Hydrochloride)- Multum, Moderate Recommendation)Aggregate Evidence QualityGrade CBenefitsImprove caregiver empowerment and health literacy and decrease anxietyMay reduce unnecessary return visitsPromotion of the medical homeRisks, harm, costIncrease caregiver anxiety and potential for caregiver intimidation in voicing concernsIncrease health care costs and length of stayBenefit-harm assessmentThe benefits of decreased caregiver anxiety and increased empowerment and health literacy outweigh the increase in cost, length of stay, and caregiver anxiety and intimidationIntentional vaguenessNoneRole of patient preferencesCaregiver may decide not to listen to clinicianExclusionsNoneStrengthModerate recommendationKey referencesNone8C.

EducationEducation will be partially achieved through the AAP communication outlets and educational services (AAP News, Pediatrics, and PREP).

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