Cardiorespiratory Events Recorded on Home Monitors

Ramanathan, Rangasamy; Corwin, Michael J.; Hunt, Carl E.; Lister, George; Tinsley, Larry; Baird, Terry M.; Silvestri, Jean M.; Crowell, David H.; Hufford, David R.; Martin, Richard J.; Neuman, Michael R.; Weese‐Mayer, Debra E.; Cupples, L A; Peucker, Mark; Willinger, Marian; Keens, Thomas G.

doi:10.1001/jama.285.17.2199

Cited by 328 publications

(189 citation statements)

References 22 publications

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“…A previous longitudinal study also identified "extreme" events that occurred with comparable frequency in otherwise normal term infants and that were not statistically increased in term infants with a history of ALTE. 34 Preterm infants have been shown to have more serious events, although an ALTE does not further increase that risk compared with asymptomatic preterm infants without ALTE. 34 Claudius and Keens 31 performed an observational prospective study in 59 infants presenting with ALTE who had been born at >30 weeks' gestation and had no significant medical illness.…”

Section: A Clinicians Need Not Admit Infants Presenting With a Lowementioning

confidence: 94%

Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants

Tieder¹,

Bonkowsky²,

Etzel³

et al. 2016

Pediatrics

142

154

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This is the fi rst clinical practice guideline from the American Academy of Pediatrics that specifi cally applies to patients who have experienced an apparent life-threatening event (ALTE). This clinical practice guideline has 3 objectives. First, it recommends the replacement of the term ALTE with a new term, brief resolved unexplained event (BRUE). Second, it provides an approach to patient evaluation that is based on the risk that the infant will have a repeat event or has a serious underlying disorder. Finally, it provides management recommendations, or key action statements, for lower-risk infants. The term BRUE is defi ned as an event occurring in an infant younger than 1 year when the observer reports a sudden, brief, and now resolved episode of ≥1 of the following: (1) cyanosis or pallor; (2) absent, decreased, or irregular breathing; (3) marked change in tone (hyper-or hypotonia); and (4) altered level of responsiveness. A BRUE is diagnosed only when there is no explanation for a qualifying event after conducting an appropriate history and physical examination. By using this defi nition and framework, infants younger than 1 year who present with a BRUE are categorized either as (1) a lower-risk patient on the basis of history and physical examination for whom evidence-based recommendations for evaluation and management are offered or (2) a higher-risk patient whose history and physical examination suggest the need for further investigation and treatment but for whom recommendations are not offered. This clinical practice guideline is intended to foster a patient-and family-centered approach to care, reduce unnecessary and costly medical interventions, improve patient outcomes, support implementation, and provide direction for future research. Each key action statement indicates a level of evidence, the benefi t-harm relationship, and the strength of recommendation.

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Section: A Clinicians Need Not Admit Infants Presenting With a Lowementioning

confidence: 94%

Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants

Tieder¹,

Bonkowsky²,

Etzel³

et al. 2016

Pediatrics

142

154

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“…Previous work 5 suggests that apnea and bradycardia are more common in premature infants than in healthy term infants or infants with idiopathic apnea and that this risk remains elevated until 43 weeks' PMA. Much of the earlier work on the epidemiology of apnea and bradycardia within premature infants centers on the effect of gestational age on the timing of the last apnea or bradycardia event.…”

Section: Figurementioning

confidence: 99%

“…Short, self-limited events or obstructive events without apnea may have been missed. 5 As a result, when a health care provider decided to discharge a patient may marginally affect these results for those infants discharged relatively soon after their last apnea or bradycardia event. This study also used information from a limited number of NICUs because of the difficulty in collecting detailed data on respiratory maturity from a large number of premature infants with complete postdischarge data.…”

Section: Figurementioning

confidence: 99%

Epidemiology of Apnea and Bradycardia Resolution in Premature Infants

2011

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WHAT'S KNOWN ON THIS SUBJECT:The maturation of respiratory control, as measured by the resolution of apnea and bradycardia events, is important for the safe management of prematurely born infants. There is little epidemiologic evidence to assess the maturation of respiratory control in premature infants. WHAT THIS STUDY ADDS:Many premature infants do not have an apnea or bradycardia event once they are otherwise ready for discharge. The risk of recurrence for apnea or bradycardia depends on gestational age and the time of the last event.abstract BACKGROUND: There is little epidemiologic evidence to assess the maturation of respiratory control in premature infants. OBJECTIVE:To measure the success rate or the percentage of infants who have no additional events of various apnea-or bradycardia-free intervals after correcting for gestational age, postmenstrual age of the last apnea or bradycardia event, and the severity of the event. METHODS:This was a retrospective cohort study of infants born at 34 weeks' gestational age or earlier at 1 of 5 Kaiser Permanente Medical Care Program hospitals between 1998 and 2001. The success rates of various apnea-or bradycardia-free intervals were calculated after stratifying according to gestational age, postmenstrual age of the last event, or event severity. RESULTS:Among the 1403 infants identified in this study, 84.2% did not have an apnea event and 78.5% did not have a bradycardia event after they were otherwise ready for discharge. For the entire cohort, a 95% success rate was statistically reached, with a 7-day apnea-or bradycardia-free interval. Infants with a gestational age of 30 weeks or less had a 5% to 15% lower success rate than infants with a gestational age more than 30 weeks for any given apnea-or bradycardia-free interval. The success rate was reduced by an additional 5% to 10% if the last apnea or bradycardia event occurred at a postmenstrual age of more than 36 weeks. Including only the most severe events slightly improved the success rate of a given interval. CONCLUSIONS:The risk of recurrence for apnea or bradycardia differs depending on the gestational age of the infant and the postmenstrual age of the last apnea or bradycardia event. Pediatrics 2011;128: e366-e373 AUTHORS:

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“…In the Collaborative Home Infant Monitoring Evaluation (CHIME) study, the symptomatic group of preterm infants at 42 to 45 weeks postconceptional age and thereafter had events similar to term controls. 100 Physiological basis for the resolution of apnea is believed to be myelination of the brainstem. Evidence supporting this notion was provided by an elegant study by Henderson-Smart et al 101 Utilizing auditory evoked responses, these investigators studied a group of babies with and without apnea and showed that brainstem conduction time was shorter in infants without apnea when compared to preterm infants with apnea.…”

Section: Other Therapiesmentioning

confidence: 99%

Apnea of prematurity: pathogenesis and management strategies

Mathew

2010

J Perinatol

109

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Apnea of prematurity (AOP) is a significant clinical problem manifested by an unstable respiratory rhythm reflecting the immaturity of respiratory control systems. This review will address the pathogenesis of and treatment strategies for AOP. Although the neuronal mechanisms leading to apnea are still not well understood, recent decades have provided better insight into the generation of the respiratory rhythm and its modulation in the neonate. Ventilatory responses to hypoxia and hypercarbia are impaired and inhibitory reflexes are exaggerated in the neonate. These unique vulnerabilities predispose the neonate to the development of apnea. Treatment strategies attempt to stabilize the respiratory rhythm. Caffeine remains the primary pharmacological treatment modality and is presumed to work through blockade of adenosine receptors A 1 and A 2 . Recent evidences suggest that A 2A receptors may have a greater role than previously thought. AOP typically resolves with maturation suggesting increased myelination of the brainstem.

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Cardiorespiratory Events Recorded on Home Monitors

Cited by 328 publications

References 22 publications

Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants

Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants

Epidemiology of Apnea and Bradycardia Resolution in Premature Infants

Apnea of prematurity: pathogenesis and management strategies

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