Home Apnea Monitors
The recommendation: Infant home apnea monitors should not be routinely used to prevent sudden infant death syndrome (SIDS).
The rationale: There is no evidence that the use of infant home apnea monitors decreases the incidence of SIDS; however, they might be of value for selected infants at risk for apnea or cardiovascular events after discharge but should not be used routinely.
Medscape spoke with Eric C. Eichenwald, MD, Chairman of the Department of Pediatrics at the University of Texas Medical School and Chief of the Department of Neonatology at Children's Memorial Hermann Hospital in Houston.
Medscape: This is a difficult recommendation because monitors may be ordered for social reasons as well as medical reasons. My question then is 2-pronged. First, what are some of the situations that might warrant ordering a home monitor?
Dr. Eichenwald: There are, of course, some babies who have respiratory instability that would warrant home monitoring. The AAP statement is saying that it's not routinely recommended for the prevention of SIDS. However, that doesn't mean that there aren't either medically dependent babies who go home or former preterm babies who have persistence apnea of prematurity for whom monitoring will get them home sooner. It's a relatively small, selective group of babies. For example, apnea of prematurity is a relatively common problem in the newborn intensive care unit. Most babies will stop having these apneic spells somewhere around 36-37 weeks postconception. But every once in a while, you'll run into a child who has a more immature breathing pattern who continues to have episodes that clinicians are concerned about. In the right circumstances with the right family who wants to take the baby home, use of a home monitor can potentially shorten the hospital stay. For an infant who continues to be on an apnea countdown and is otherwise fine, eating well, and not having significant events, we may tell parents that a monitor for a month or 2 at home will allow them to get home sooner. Many parents will opt for that because that way they get out of the hospital. But these are kids who have already demonstrated abnormality in breathing. That's one category.
Another category would be babies who have airway abnormalities perhaps as a result of a tracheotomy, or they might be sent home on oxygen. Some clinicians will choose to have those babies at home on a monitor as well just to be able to notify the family if there's a problem while the baby is sleeping.
A third category is not encountered frequently but is the older child, 2-3 months old, who has experienced an apparent life-threatening event. If the cause cannot be determined, some would recommend sending those children home on a monitor.
The important point is that it is a relatively select group of children with specified abnormalities for whom home apnea monitoring is indicated. This is in contrast to a blanket approach, which used to happen in some locales, in which every preterm baby goes home on a monitor.
Medscape: And for infants who fall outside of those conditions and for whom monitoring is not indicated, what are some strategies you would recommend to reassure families about this decision?
Dr. Eichenwald: In my practice, we just don't bring it up unless the parents do because it's not really an accepted practice in Texas. In other places in the country, home monitoring is used more routinely. In most practices, there is a standard period of time after an infant's last apneic episode where monitoring is done. At that point, we declare that the apnea has resolved and that the babies can go home. If the parent asks about a monitor, I would say it's not indicated because the apnea was developmental and is now resolved. The baby's respiratory control has developed and is now more normal. Apnea of prematurity is not a predictor of SIDS. There really isn't any indication for using home monitoring in a former preterm baby. The most important thing in these situations is to reinforce the AAP recommendations for safe infant sleeping and SIDS prevention.[14] Using a home monitor is not a method to prevent SIDS. There are things that you can advise your patient's families to do that have been shown to decrease the risk for SIDS. These are familiar by now and include not putting the infant to sleep on the stomach, not placing a lot of stuff in the crib, breastfeeding, no smoking in the household, and avoiding cosleeping with the baby. There are parental behaviors and interventions that can be made that make SIDS much less likely and lower the risk. Parents can make sure other persons caring for their baby, such as daycare providers, are following these same rules. Those things should be reinforced with all parents and are going to be a much more significant intervention than using a monitor.