Brief Resolved Unexplained Events and Gastro-oesophageal reflux

It is very easy to start treatment for presumed gastro-oesophageal reflux (GOR) in a well infant who has presented with a Brief Resolved Unexplained Event (BRUE) which has been classified as low risk. Lucina has never been convinced that gastro-oesophageal reflux is a major cause for BRUEs or what used to be known as an Apparently Life Threatening Event (ALTEs) until 2016 [Pediatrics 2016;137 (5):e20160590]. Duncan et al. [J Pediatrics 2019 https://doi.org/10.1016/j.jpeds.2019.04.007] have examined a retrospective cohort of infants from Bostons’ Childrens hospital who had been diagnosed with BRUE as per the American Academy of Paediatrics guidelines. They looked 1 year before and 1 year after guideline implementation to determine if practice patterns have changed. They looked at 359 subjects (186 pre-, 173 post-guidelines). There were no significant differences in practice patterns or outcomes before or after guideline implementation. Each subject had over two diagnostic tests performed, and 89% were noncontributory. Interestingly, 13% had a videofluoroscopic swallow study performed, and 72% showed aspiration/penetration. No subject had gastro-oesophageal reflux testing, yet reflux was …