Monitoring Apnea of Prematurity: Validity of Nursing Documentation and Bedside Cardiorespiratory Monitor

Abstract

Objective To compare apnea events recorded by bedside cardiorespiratory monitor and nursing documentation with those detected by visual inspection of continuous electronic cardiorespiratory waveform.

Methods In a prospective observational study, 20 nonventilated infants of 28 to 33 weeks' gestational age were monitored for apnea during the first 2 postnatal weeks. Apnea was defined as a respiratory pause > 20 seconds or > 15 seconds if associated with a heart rate < 80/min or oxygen saturation < 85%. True apnea was defined as one for which visual inspection of continuous electronic cardiorespiratory waveform on the central monitor verified apnea.

Results The number of apnea episodes recorded by nursing documentation and bedside monitors were 207 and 418, respectively. Only 7.7% of apnea events recorded by nursing documentation were confirmed as true apnea compared with 50.4% of apnea recorded by bedside monitors and the difference was statistically significant. Of true apnea (n = 211) episodes recorded on central monitors, 99% were recorded by bedside monitors but only 7.6% of apnea occurrences were recorded by nursing personnel.

Conclusions Nursing documentation does not provide accurate monitoring of apnea. Although bedside monitors have better sensitivity and specificity than nursing documentation, future research should be directed to improve the specificity of bedside monitoring.

Keywords

neonatal intensive care unit - bradycardia - desaturation - premature infants

• References

• 1 Miller MJ, Martin RJ. Apnea of prematurity. Clin Perinatol 1992; 19: 789-808
• 2 Eichenwald EC, Aina A, Stark AR. Apnea frequently persists beyond term gestation in infants delivered at 24 to 28 weeks. Pediatrics 1997; 100 (3 Pt 1) 354-359
• 3 Baird TM. Clinical correlates, natural history and outcome of neonatal apnoea. Semin Neonatol 2004; 9: 205-211
• 4 Di Fiore JM. Neonatal cardiorespiratory monitoring techniques. Semin Neonatol 2004; 9: 195-203
• 5 Darnall RA, Kattwinkel J, Nattie C, Robinson M. Margin of safety for discharge after apnea in preterm infants. Pediatrics 1997; 100: 795-801
• 6 Razi NM, Humphreys J, Pandit PB, Stahl GE. Predischarge monitoring of preterm infants. Pediatr Pulmonol 1999; 27: 113-116
• 7 Nathanson I, O'Donnell J, Commins MF. Cardiorespiratory patterns during alarms in infants using apnea/bradycardia monitors. Am J Dis Child 1989; 143: 476-480
• 8 Weese-Mayer DE, Brouillette RT, Morrow AS, Conway LP, Klemka-Walden LM, Hunt CE. Assessing validity of infant monitor alarms with event recording. J Pediatr 1989; 115 (5 Pt 1) 702-708
• 9 Bell EF, Strauss RG, Widness JA , et al. Randomized trial of liberal versus restrictive guidelines for red blood cell transfusion in preterm infants. Pediatrics 2005; 115: 1685-1691
• 10 Mitchell AJ, Green A, Jeffs DA, Roberson PK. Physiologic effects of retinopathy of prematurity screening examinations. Adv Neonatal Care 2011; 11: 291-297
• 11 Murphy JJ, Swanson T, Ansermino M, Milner R. The frequency of apneas in premature infants after inguinal hernia repair: do they need overnight monitoring in the intensive care unit?. J Pediatr Surg 2008; 43: 865-868
• 12 Carbone T, McEntire B, Kissin D , et al. Absence of an increase in cardiorespiratory events after diphtheria-tetanus-acellular pertussis immunization in preterm infants: a randomized, multicenter study. Pediatrics 2008; 121: e1085-e1090
• 13 Amin SB, Charafeddine L, Guillet R. Transient bilirubin encephalopathy and apnea of prematurity in 28 to 32 weeks gestational age infants. J Perinatol 2005; 25: 386-390
• 14 Janvier A, Khairy M, Kokkotis A, Cormier C, Messmer D, Barrington KJ. Apnea is associated with neurodevelopmental impairment in very low birth weight infants. J Perinatol 2004; 24: 763-768
• 15 Taylor HG, Klein N, Schatschneider C, Hack M. Predictors of early school age outcomes in very low birth weight children. J Dev Behav Pediatr 1998; 19: 235-243
• 16 Cheung PY, Barrington KJ, Finer NN, Robertson CM. Early childhood neurodevelopment in very low birth weight infants with predischarge apnea. Pediatr Pulmonol 1999; 27: 14-20
• 17 Di Fiore JM, Arko MK, Miller MJ , et al. Cardiorespiratory events in preterm infants referred for apnea monitoring studies. Pediatrics 2001; 108: 1304-1308
• 18 Muttitt SC, Finer NN, Tierney AJ, Rossmann J. Neonatal apnea: diagnosis by nurse versus computer. Pediatrics 1988; 82: 713-720
• 19 Zupancic JA, Richardson DK, O'Brien BJ, Eichenwald EC, Weinstein MC. Cost-effectiveness analysis of predischarge monitoring for apnea of prematurity. Pediatrics 2003; 111: 146-152