PubMed · 8780136
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J S Jeret. 1996. Apnea testing.. https://doi.org/10.1212/wnl.46.4.1192-b
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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.
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To gain information on the cardiorespiratory changes occurring immediately before sudden infant death (SID), recordings of heart rate and chest wall impedance were analyzed in nine infants who had died at a median age of 4.8 mo (range 1-6 mo) while attached to a memory monitor. Postmortem diagnoses were sudden infant death syndrome in seven infants and mild bronchopulmonary dysplasia in two infants. Primary cause of the monitor alarm was bradycardia in all but two infants. Heart rate fell to < or = 15 bpm 7.5 min (range 1.4-25.2 min) after the first alarm; there was no indication of heart block or ventricular tachycardia. Apnea (> 20 s) began 0.3 to 13.7 min (median 2.7 min) after this alarm in five infants and 7 to 20 s before it in three infants; in the remaining infant, stimulation occurred before any apnea. Gasping was already present at the time of the first monitor alarm in three infants and occurred within 2.7 min after it in a further four infants. One infant only began to gasp 13 min after the first monitor alarm. The duration of gasping ranged from 3 s to 11 min in those five infants in whom it was not interrupted by resuscitation. The latter was given to three infants 4, 21, and 228 s after the monitor alarm but had no effect on the ongoing decrease in heart rate. Since gasping only occurs if PaO2 is < 5-15 mm Hg, it is most likely that the seven infants who gasped at or shortly after the first monitor alarm were already severely hypoxemic at that time. This hypoxemia developed in the absence of prolonged central apnea. The role of other mechanisms potentially resulting in severe hypoxemia, such as upper airway obstruction or rebreathing, remains to be determined.