Infants' Feeding Habits and Brief Resolved Unexplained Events (BRUEs): A Prospective Observational Study

Background: A brief resolved unexplained event (BRUE) is a brief, sudden episode occurring in infants younger than 1 year of age, characterized by some combination of absent, decreased, or irregular breathing, an altered level of responsiveness, color change, and change in muscle tone. Although inappropriate feeding has been suggested as playing a role in the occurrence of BRUEs, only anecdotal reports have been described. The main objective of our study was to objectively evaluate whether overfeeding may represent a risk factor for the occurrence of BRUEs. Methods: We enrolled 42 infants aged 0-6 months and admitted for BRUE episodes and the same number of age- and sex-matched healthy infants who served as controls. Data about feeding practices and auxological parameters of each enrolled infant were collected and analyzed, along with clinical data about the pre- and post-natal period. The primary outcome measures were mean daily body weight gain, daily number of feedings, mean volume of feedings, and average daily volume only for bottle-fed infants. Results: The mean (+/- SD) daily body weight gain, the only available and reliable parameter to assess feeding adequacy in both breast- and formula-fed infants, was 41 +/- 15 g in infants with BRUEs vs. 35 +/- 11 g in healthy infants (95% CI [0.21; 11.8], p = 0.042). Moreover, infants with BRUEs were more likely to receive mixed breastfeeding than controls, although this difference did not reach statistical significance (33% vs. 17%, 95 CI [-0.04; 0.37], p = 0.131). Conclusions: Overfeeding seems to be a risk factor for BRUEs, either through milk inhalation, choking, or GER worsening. Detecting inappropriate feeding practices and providing appropriate education may help prevent the BRUE produced by either scenario.