The History of Home Cardiorespiratory Monitoring

Abstract

Home cardiorespiratory monitoring has changed significantly since it was first introduced in the 1970s. It has improved from a simple alarm system to a sophisticated piece of equipment capable of monitoring the patient's electrocardiogram, respiratory effort, and oxygen saturations. In addition, the indications for using a monitor have also changed. The home monitor was initially used to reduce the incidence of sudden infant death syndrome (SIDS). Although there were several studies demonstrating the reduction of SIDS rates in communities where apnea programs existed, none was a prospective, double-blinded study or had adequate numbers to be clinically significant. Therefore, the American Academy of Pediatrics took the stance that monitors were not an effective way to reduce SIDS. However, when used appropriately, as part of a complete program (ie, the monitor is just one of many clinically based modalities), by a clinician with expertise in interpreting download tracings, home cardiorespiratory monitoring can be a useful, lifesaving, and economical tool to observe infants who are at increased risk of sudden death or increased morbidity secondary to intermittent hypoxia. [Pediatr Ann. 2017;46(8):e303-e308.].

Initial Experience and Usage Patterns With the Owlet Smart Sock Monitor in 47,495 Newborns

“…Use of pulse oximetry and cardiorespiratory monitors in the home setting has been long debated and has been a controversial topic ever since the introduction of such monitors in early 1970s. 6 The history is well summarized in a recent article by Freed and Martinez. 6 …”

“…Freed and Martinez 6 provided data from a comprehensive home cardiorespiratory monitoring program of more than 35,000 infants from August 1998 to December 2016. Their most recent hypothesis about the utility of cardiorespiratory monitoring suggests that the monitoring of a select group of infants who are at risk for episodes of intermittent hypoxemia has merit and bears serious consideration.…”

“…Importantly, we point out the utility of the OSS in regard to the future opportunities that it may offer to improve access to outpatient and at-home physiological monitoring of infants with specific medical conditions. 5 , 6 …”

Apnea of Prematurity: An Update

“…However, this hypothesis was never proven and no prospective data showed an effect on sudden unexpected infant death (SUID) rates, leading to the AAP 94 recommendation against their routine use. 95 The Collaborative Home Infant Monitoring Evaluation Study showed that preterm infants had more events than SIDS siblings, infants that had experienced an apparent life threatening event (ALTE) event or healthy infants. "Extreme events" (apnea >30 seconds and/or heart rate 10 seconds) were common in preterm infants but very rare after 43 weeks postconceptual age.…”

“…They may serve as a diagnostic tool with careful review of downloads suggesting such diagnoses as gastroesophageal reflux, arrhythmias, and seizures, and it has been suggested that an increase in alarms may be an early sign of an respiratory syncytial virus (RSV) infection. 95 Apnea monitors have the potential of being cost-effective devices, enabling early NICU discharge, reducing family costs, and decreasing time off from work. A recent study by Montenegro et al showed that a hypothetical outpatient management plan could lead to $2,422 to $62 being saved per eligible patient.…”