Abstract â–¡ 58

Home cardiorespiratory monitors (HCRM) were suggested as a way to prevent SIDS in the 1970's. Despite a lack of evidence of benefit, they continue to be prescribed. The major groups are: SIDS siblings; infants with Apparent Life Threatening Events (ALTE); preterm infants (all or specific subgroups). The early monitors recorded heart rate and respiratory rate and alarmed at specific rates of bradycardia and duration of respiratory pause. Newer monitors document timing and duration of events (most of which are related to technical difficulties and not to bradycardia nor apnea). SaO2 monitors are used for home use by some, particularly infants on home O2 therapy.

We report trends in HCRM in southern Alberta. The Alberta Children's Hospital is the referral centre for a population of 1.2 million, approximately 22,000 deliveries per year. All HCRM in this area are supplied at the Alberta Children's Hospital since 1982. No vendors have supplied HCRM directly to patients. All infants requiring assessment for apnea are referred to ACH as are all infants on home O2. SaO2 are not used at home.

Monitor use is shown: (Table)

Table 1
Full size table

There has been a steady fall in numbers and duration of HCRM prescribed. The trend was temporarily reversed in 1993-4 and 1997 related to recruitment of new staff. SIDS rates have fallen from 1.98/1000 live births in 1982 to 0.89 in 1995.

This fall in HCRM has occurred because of: continued physician education and critical review of literature; close contact and support of patient groups; demedicalizing of the NICU graduate and encouraging those parents to focus on the child's development and social needs; a centralized program involving a small number of personnel. Conflict has been avoided by working with parents and physicians and accepting occasional use of HCRM for parental or physician anxiety.

Rational limited use of HCRM is possible without major conflict with a consistent, supportive approach.