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Cardiorespiratory events recorded on home monitors: Comparison of healthy infants with those at increased risk for
R Ramanathan1, M J Corwin, C E Hunt
1Department of Pediatrics, Yale Medical School, Box 208064, New Haven, CT 06520-8064, USA.
Insights
Home cardiorespiratory monitors are common for infants at risk of sudden infant death syndrome (SIDS), but this study found extreme events rare in term infants. Preterm infants showed increased risk until 43 weeks postconception.
Area of Science:
- Pediatrics
- Neonatology
- Cardiorespiratory Monitoring
Background:
- Home cardiorespiratory monitors are widely used for infants at increased risk for sudden infant death syndrome (SIDS).
- The efficacy of these devices in identifying cardiorespiratory events in at-risk infants remains unproven.
Purpose of the Study:
- To investigate the hypothesis that preterm infants, SIDS siblings, and infants with apparent life-threatening events have a higher risk of cardiorespiratory events compared to healthy term infants.
- To evaluate the frequency and characteristics of cardiorespiratory events in various infant groups.
Main Methods:
- A longitudinal cohort study involving 1079 infants was conducted across five US metropolitan medical centers from May 1994 to February 1998.
- Infants were monitored at home for the first six months using respiratory inductance plethysmography to detect apnea and obstructed breathing.
- Cardiorespiratory events exceeding conventional and extreme alarm thresholds were recorded.
Main Results:
- Over 718,000 hours of monitoring, 41% of infants experienced events exceeding conventional thresholds, and 10% had extreme events.
- Extreme events were similarly frequent across term infant groups but showed increased risk in preterm infants up to 43 weeks postconceptional age.
- Approximately 70% of extreme apnea events included at least three obstructed breaths, suggesting limitations of conventional monitoring techniques.
Conclusions:
- Conventional cardiorespiratory events are common in infants, including healthy term infants.
- Extreme events were primarily observed in preterm infants and are unlikely to be immediate precursors to SIDS.
- The high incidence of obstructed breathing highlights the need for improved monitor design and accurate risk assessment for cardiorespiratory events.
Context:
Home monitors designed to identify cardiorespiratory events are frequently used in infants at increased risk for sudden infant death syndrome (SIDS), but the efficacy of such devices for this use is unproven.
Objective:
To test the hypothesis that preterm infants, siblings of infants who died of SIDS, and infants who have experienced an idiopathic, apparent life-threatening event have a greater risk of cardiorespiratory events than healthy term infants.
Design:
Longitudinal cohort study conducted from May 1994 through February 1998.
Setting:
Five metropolitan medical centers in the United States.
Participants:
A total of 1079 infants (classified as healthy term infants and 6 groups of those at risk for SIDS) who, during the first 6 months after birth, were observed with home cardiorespiratory monitors using respiratory inductance plethysmography to detect apnea and obstructed breathing.
Main Outcome Measures:
Occurrence of cardiorespiratory events that exceeded predefined conventional and extreme thresholds as recorded by the monitors.
Results:
During 718 358 hours of home monitoring, 6993 events exceeding conventional alarm thresholds occurred in 445 infants (41%). Of these, 653 were extreme events in 116 infants (10%), and of those events with apnea, 70% included at least 3 obstructed breaths. The frequency of at least 1 extreme event was similar in term infants in all groups, but preterm infants were at increased risk of extreme events until 43 weeks' postconceptional age.
Conclusions:
In this study, conventional events are quite common, even in healthy term infants. Extreme events were common only in preterm infants, and their timing suggests that they are not likely to be immediate precursors to SIDS. The high frequency of obstructed breathing in study participants would likely preclude detection of many events by conventional techniques. These data should be important for designing future monitors and determining if an infant is likely to be at risk for a cardiorespiratory event.
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