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Apnea, bradycardia and desaturation spells in premature infants: impact of a protocol for the duration of ‘spell-free’ observation on interprovider variability and readmission rates



To study the impact of implementing a protocol to standardize the duration of observation in preterm infants with apnea/bradycardia/desaturation spells before hospital discharge on length of stay (LOS) and readmission rates.

Study design:

A protocol to standardize the duration of in-hospital observation for preterm infants with apnea, bradycardia and desaturation spells who were otherwise ready for discharge was implemented in December 2013. We evaluated the impact of this protocol on the LOS and readmission rates of very low birth weight infants (VLBW). Data on readmission for apnea and an apparent life-threatening event (ALTE) within 30 days of discharge were collected. The pre-implementation epoch (2011 to 2013) was compared to the post-implementation period (2014 to 2016).


There were 426 and 368 VLBW discharges before and after initiation of the protocol during 2011 to 2013 and 2014 to 2016, respectively. The LOS did not change with protocol implementation (66±42 vs 64±42 days before and after implementation of the protocol, respectively). Interprovider variability on the duration of observation for apneic spells (F–8.8, P=0.04) and bradycardia spells (F–17.4, P<0.001) decreased after implementation of the protocol. The readmission rate for apnea/ALTE after the protocol decreased from 12.1 to 3.4% (P=0.01).


Implementing an institutional protocol for VLBW infants to determine the duration of apnea/bradycardia/ desaturation spell-free observation period as recommended by the American Academy of Pediatrics clinical report did not prolong the LOS but effectively reduced interprovider variability and readmission rates.

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PC: supported by University at Buffalo, and Dr. Henry C. and Bertha H. Buswell Grant. MR: Canadian Paediatric Society (Neonatal Resuscitation Program). AMR: Developmental Impact of NICU Exposures (DINE) (UG3 OD023320) and Environmental Influences on Child Health Outcomes (ECHO) Program. SL: AAP (Neonatal Resuscitation Program) and NICHD RO1HD072929.

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Correspondence to P Chandrasekharan.

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Supplementary Information accompanies the paper on the Journal of Perinatology website

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Chandrasekharan, P., Rawat, M., Reynolds, A. et al. Apnea, bradycardia and desaturation spells in premature infants: impact of a protocol for the duration of ‘spell-free’ observation on interprovider variability and readmission rates. J Perinatol 38, 86–91 (2018).

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