Related Experiment Videos
Predischarge monitoring of preterm infants
N M Razi1, J Humphreys, P B Pandit
1Department of Pediatrics, Children's Regional Hospital at Cooper Hospital/University Medical Center, and University of Medicine and Dentistry of New Jersey/Robert Wood Johnson Medical School, Camden 08103, USA.
Insights
Documented event-monitoring (DEM) for apnea and bradycardia in preterm infants is more accurate than nursing documentation (ND). DEM provides objective data, while ND significantly underreports true events and misclassifies infant status before discharge.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Clinical Nursing
Background:
- Premature infants are at high risk for apnea and bradycardia.
- Accurate monitoring is crucial for safe discharge.
- Current nursing documentation (ND) may not fully capture these events.
Purpose of the Study:
- To conduct documented event-monitoring (DEM) for apnea (A) and bradycardia (B) in preterm infants before discharge.
- To evaluate the accuracy of nursing documentation (ND) in recording these events.
Main Methods:
- DEM was performed on 44 stable preterm infants for 9 days prior to discharge.
- Data from DEM were compared with ND using statistical analysis (z-test for proportions).
Main Results:
- DEM recorded 561 true events (56 A, 505 B), while ND documented 296 events (190 A, 106 B).
- ND correctly reported only 38% of true apnea events and 30% of true bradycardia events.
- ND misclassified 10 infants, failing to detect significant events in some and reporting events in others not present on DEM.
Conclusions:
- Nursing documentation significantly underestimates the incidence of apnea and bradycardia in preterm infants.
- Documented event-monitoring provides more objective and accurate data for assessing infant readiness for discharge.
- Improved monitoring protocols are needed to ensure accurate assessment of cardiorespiratory events in high-risk neonates.
Abstract:
The objectives of this study were: 1) to perform documented event-monitoring (DEM) for apnea (A, > or = 20 s) and bradycardia (B, < 80 beats per min for > or = 5 s) in premature infants prior to discharge, and 2) to examine the accuracy of nursing documentation (ND) of A and B. Forty-four stable preterm infants, with mean weights and gestational ages at birth (+/- SD) of 1,543 (+/- 365) g, and 30 (+/- 2) weeks, respectively, were studied using DEM for 9 (+/- 2) days prior to discharge. Differences in DEM and ND were analyzed by the z-test for proportions. There were 561 true events recorded by DEM: 56 were As and 505 were Bs. ND revealed 296 events, 190 As and 106 Bs. Of the 56 true As on DEM, only 21 (38%) were correctly reported by ND (P < 0.001, 95% confidence interval (CI) 0.44-0.81). Of the 505 true Bs on DEM, 153 (30%) were correctly reported by ND (P < 0.001, CI 0.63-0.76). When ND was compared with DEM, 174 (59%) of NDs were true events. Of the 106 As on ND, only 21 (20%) were true As on DEM (P < 0.001, CI 0.58-1). Of the 190 Bs on ND, 153 (80%) were true Bs on DEM (P < 0.001, CI 0.13-0.26). ND did not detect 6 of the 33 infants who had significant events on DEM, while 4 of the 11 who had events reported on ND did not have any on DEM. Thus, 10 infants were misclassified by ND (P < 0.01, CI 0.1-0.36). These results indicate that, compared to DEM, ND not only identified significantly fewer true As and Bs, but also misclassified a significant number of infants. We conclude that DEM performed prior to discharge for preterm infants at risk for apnea and bradycardia provides more objective and accurate information than ND.