Abstract □ 52

In the province of Quebec, Canada (population: 7,000,000; annual live births: 80,000), home cardiorespiratory monitoring programs are centralized in 8 centres throughout the province. Only specially trained health professionals (physicians and nurses) in those centres investigate cases of ALTE, make recommendations for home monitoring, and follow infants while they are on monitor. Former premature infants discharged on home monitors are also followed in those centres only. Over the past 8 years, gradually all "standard" monitors were replaced by event recorders so that documented monitoring is now available for almost all patients of the province for the whole duration of the monitoring period. Because statistics are carefully kept by all centers, we have been able to follow the evolution of home monitoring in the province over time.

Our most recent survey shows a significant drop in the number of ALTE cases through the province in the past few years. This drop occurred at approximately the same time as the marked drop in SIDS rate following the campaign to avoid prone sleeping for infants. There has been no significant drop in the number of cases in other categories (SIDS siblings and former premature infants having persistant apnea and bradycardia).

Criteria used to stop home monitoring have changed over the past ten years. In the 1980's, for instance, home monitoring was not stopped before the age of six to nine months and the infants had to be free of significant events (alarms of the monitor felt to represent significant events) for two months. In the past five years, we have use the criterion of two months without documented significant events. This new criterion used with documented monitoring has resulted in a much shorter monitoring period.

There has been no death of infants in home monitoring programs for ALTE neither during the monitoring period nor in the months following, up to an age of 18 months.

Our province-wide network for home cardiorespiratory monitoring services has provided important information concerning the evolution of monitoring in the past decade. With the marked recent decreases in SIDS rates in Quebec, which seems to be paralleled by a decrease in the incidence of ALTE, a reevaluation of monitoring programs has to be undertaken. Information coming from other regions of the world would be crucial to help us find the best strategies.