The historical term ALTE (now replaced with "BRUE") was defined by a consensus conference in 1986 as:
"An episode that is frightening to the observer and that is characterized by some combination of apnea (central or occasionally obstructive), color change (usually cyanotic of pallid but occasionally erythematous or plethoric), marked change in muscle tone (usually marked limpness), choking, or gagging. In some cases, the observer fears that the infant has died. Previously used terminology such as "aborted crib death" or "near-miss SIDS should be abandoned because it implies a possibly misleadingly close association between this type of spell and SIDS."
In the literature, ALTE has been defined in different manners giving an estimated to be 0.05 to 1 percent incidence. Most of these episodes occur before 2 months of age (especially before 10 weeks of age). Risk factors for having an ALTE are prior episodes, respiratory illness, young age, materal smoking, prematurity, post-mature infants and first-born infants.
BRUE was defined in the 2016 AAP clinical practice guideline as:
Clinicians should use the term BRUE to describe an event occurring in an infant <1 year of age when the observer reports a sudden, brief, and now resolved episode of ≥1 of the following:
- Cyanosis or pallor
- Absent, decreased, or irregular breathing
- Marked change in tone (hyper or hypotonia)
- Altered level of responsiveness
Moreover, clinicians should diagnose a BRUE only when there is no explanation for a qualifying event after conducting an appropriate history and physical examination
National Institutes of Health Consensus Development Conference on Infantile Apnea and Home Monitoring, Sept 29 to Oct 1, 1986.
Early neonatal sudden infant death and near death of fullterm infants in maternity wards.
Polberger S, Svenningsen NW
Acta Paediatr Scand. 1985;74(6):861.
Apnea of infancy--a clinical problem.
Davis N, Sweeney LB
West J Med. 1986;144(4):429.
The epidemiology of sudden infant death syndrome and attacks of lifelessness in Sweden.
Wennergren G, Milerad J, Lagercrantz H, Karlberg P, Svenningsen NW, Sedin G, Andersson D, Grögaard J, Bjure J
Acta Paediatr Scand. 1987;76(6):898.
Apparent life-threatening prolonged infant apnea in Saskatchewan.
Sunkaran K, McKenna A, O'Donnell M, Ninan A, Kasian G, Skwarchuk J, Bingham WT
West J Med. 1989;150(3):293.
Epidemiology of apparent life threatening events.
Kiechl-Kohlendorfer U, Hof D, Peglow UP, Traweger-Ravanelli B, Kiechl S
Arch Dis Child. 2005;90(3):297.
Surveillance study of apparent life-threatening events (ALTE) in the Netherlands.
Semmekrot BA, van Sleuwen BE, Engelberts AC, Joosten KF, Mulder JC, Liem KD, Rodrigues Pereira R, Bijlmer RP, L'Hoir MP
Eur J Pediatr. 2010 Feb;169(2):229-36.
Apparent life-threatening events: an update.
Fu LY, Moon RY
Pediatr Rev. 2012 Aug;33(8):361-8;
Apparent life-threatening events and sudden infant death syndrome: comparison of risk factors.
Esani N, Hodgman JE, Ehsani N, Hoppenbrouwers T
J Pediatr. 2008;152(3):365.