Investigators from Boston Children’s Hospital (BCH), Boston, MA, conducted a prospective study to assess the persistent of symptoms following hospitalization for a brief resolved unexplained event (BRUE) in young infants and identify risk factors for persistent symptoms. Study participants were infants <1 year old admitted to BCH between April 2017 and May 2021 with a diagnosis of BRUE, defined as an episode of cyanosis or pallor; absent, decreased, or irregular breathing; marked changes in tone; or an altered level of responsiveness. Parents of enrolled patients completed baseline symptom and medical history questionnaires and the Infant Gastroesophageal Reflux Questionnaire Revised (I-GERQ-R), a validated instrument for determining significant gastroesophageal reflux disease. The medical records for study children were reviewed to identify diagnostic evaluations including beside clinical feeding evaluations (CFE), videofluoroscopic swallow studies (VFSS), explanatory diagnoses provided to parents, and treatments. Following hospital discharge, parents were sent questionnaires every 2 weeks for 2 months to document occurrence of symptoms (coughing, spitting up, choking, red/watery eyes, fussiness, BRUE spells, congestion/noisy breathing). Any symptom that was reported on more than 1 questionnaire was considered persistent. Medication or feeding treatment changes also were documented. The medical records of study patient were reviewed for 6 months following the index hospitalization to identify subsequent emergency department (ED) visits and hospitalizations for BRUE. The primary study outcome was persistent symptoms. Secondary outcomes included diagnostic evaluations, therapies, and subsequent health care use. Risk factors for persistent symptoms, including demographic characteristics, treatments, and aspiration status (determined during hospitalization), were identified using regression analysis after controlling for age at hospitalization, history of prematurity, and breastfeeding status.
A total of 124 infants hospitalized for BRUE at a mean age or 51.6 ±5.9 days were enrolled; 24% of these children had been born prematurely. The most common explanation for the BRUE was gastroesophageal reflux (52 patients, 42%); however, I-GERQ-R scores were not statistically associated with a diagnosis of reflux. During the index hospitalization, 49% of infants underwent CFE, and 33 had VFSS either during the hospitalization or subsequently; 67% of VFSS were abnormal. Among 90 parents of study patients completing at least 1 follow-up questionnaire, 86% reported persistent symptoms in their child, including 65% with choking with feeds and 12% with recurrent BRUE spells. Acid suppression therapy was prescribed for 27 study children (30%), and thickened feeds were started in 24 (27%). Following their index hospitalization, 18 (15%) had an ED visit and/or hospitalization for recurring BRUE symptoms. In the multivariate model, thickening feeds was associated with a significantly decreased risk of persistent symptoms (relative risk, 0.77; 95% CI, 0.60, 0.97). There was no statistically significant association with persistent symptoms for any other potential risk factor assessed, including documented aspiration, acid suppression therapy, or use of hypoallergenic formula.
The authors conclude...