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Apnea frequently persists beyond term gestation in infants delivered at 24 to 28 weeks
E C Eichenwald1, A Aina, A R Stark
1Department of Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Insights
Apnea of prematurity often continues past the due date in very premature infants. This condition can lead to longer hospital stays, requiring careful management for earlier discharge.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Perinatology
Background:
- Apnea of prematurity is a common diagnosis in Neonatal Intensive Care Units.
- Improved survival rates in extremely premature infants necessitate reassessing apnea's natural history.
Purpose of the Study:
- To document the natural history of recurrent apnea and/or bradycardia events.
- To analyze these events in infants born between 24 and 28 weeks' gestation.
Main Methods:
- Retrospective review of medical records for infants born at 24-28 weeks' gestation.
- Inclusion criteria: infants admitted to NICU and discharged home or to an affiliated hospital.
- Data collection based on nursing observations of monitor alarms and infant condition.
Main Results:
- Recurrent apnea/bradycardia resolution time correlated with lower gestational age.
- Events frequently persisted beyond 36 weeks' postconceptional age across all groups.
- Higher incidence of apnea beyond 38 weeks postconceptional age observed in infants born at 24-27 weeks compared to 28-week infants.
Conclusions:
- Apnea of prematurity commonly persists beyond term gestation in infants born at 24-28 weeks.
- Persistent events may prolong hospitalization, impacting discharge planning.
- Management strategies must consider the variability in apnea resolution for earlier infant discharge.
Background:
Apnea of prematurity remains among the most commonly diagnosed conditions in the Newborn Intensive Care Unit and may prolong hospital stays in some infants. Because survival of extremely premature infants has improved markedly, the natural history of apnea in this population needs to be reassessed.
Objective:
To document the natural history of recurrent apnea and/or bradycardia events in infants delivered at 24 to 28 weeks' gestation.
Methods:
Medical records of all infants delivered at 24 to 28 weeks' gestation admitted to the Brigham and Women's Hospital Newborn Intensive Care Unit between January 1989 and March 1994 were reviewed to document the clinical course of apnea of prematurity. Subjects were included in the study sample if they were discharged home from the Brigham and Women's Hospital or after transfer to an affiliated hospital. Recordings of apnea and/or bradycardia events were based on nursing observations of monitor alarms and assessment of the infant's condition.
Results:
Of 457 eligible infants, 226 were included in the study sample and stratified by gestational age at birth assigned by the attending neonatologist. The time to resolution of recurrent apnea/bradycardia events was longer with lower gestational age at birth. Apnea/bradycardia events were frequently observed beyond 36 weeks' postconceptional age in all gestational age groups. The incidence of apnea persisting beyond 38 weeks postconceptional age was significantly higher in the 24- to 27-week infants combined compared with the 28-week infants.
Conclusions:
Apnea of prematurity frequently persists beyond term gestation in infants delivered at 24 to 28 weeks' gestational age. These persistent apnea and/or bradycardia events may contribute to prolonged hospitalization. Programs to promote earlier discharge of premature infants should take into account the variability in resolution of apnea and specifically address management of persistent apnea.