Definitions and monitoring methods for apnea in preterm infants: a scoping review

Despite the ubiquity of apnea among preterm infants, optimal definitions and monitoring practices remain unknown. This scoping review aims to describe the clinical methods used to monitor apnea in preterm infants and apnea definitions employed across the neonatal literature.

A search was performed in Cochrane Library, EMBASE, MEDLINE, and Web of Science for studies published in the last 25 years employing monitoring devices or algorithms for the purpose of identifying apneas in premature infants. Data surrounding participant information, devices employed, and apnea definitions were extracted.

Across 176 included studies, 12 different devices were used to monitor breathing efforts and 7 devices to monitor respiratory airflow with the aim of capturing apneas. Methods for monitoring airflow remain limited in sensitivity and feasibility. Of 164 apnea definitions extracted from the studies, 110 (67%) consisted only of a minimum duration of the respiratory pause, while 54 (33%) additionally cited the presence of bradycardia and/or oxygen desaturation.

Significant variability exists in the methods used to detect apneas and the definitions employed in the current literature. Enhanced tools for monitoring apneas and standardized guidelines for defining apneas in preterm infants are needed.

This scoping review offers a comprehensive overview of the methods used to detect apneas in preterm infants, as well as the definitions of apnea employed in neonatal research. The marked variability in apnea monitoring practices and definitions underscores the pressing need for standardization across clinical and research settings. Advancing standardized approaches may require targeted research efforts leveraging multimodal and longitudinal monitoring to better capture the complexity of apnea in preterm infants.