Abstract 1492

Objective: Bradycardia and pathologic apnea in premature infants pose a risk of infant morbidity, delay hospital discharges, and contribute to parental anxiety. Our objective was to determine whether a documented event monitor (DEM) recording is useful in screening healthy preterm infants for pathologic apnea and bradycardia at the time of discharge. Methods: We reviewed 246 DEM recordings for preterm infants under 36 weeks corrected gestational age (CGA) prior to their discharge. Infants were discharged on DEM and received telephone follow-up for 6 months or until monitor no pathologic events were noted for 6 to 8 weeks. Sixteen infants were excluded due to non-compliance with the monitor. Abnormal events were defined as apnea greater than 20 seconds, apnea less than 20 seconds with bradycardia (<80 beats per minute), and isolated bradycardia. Results: Mean gestational age (GA) was 32 ± 0.2 weeks SEM. Mean CGA at time of study and hospital discharge was 34.6 ± 0.1 weeks SEM. (Table) The sensitivity, specificity, and positive predictive value of the initial study compared with follow-up at age 1 to 2 months for pathologic events are 50.5%, 74.8%, and 63.5%, respectively. CGA at time of last abnormal event was 37.2 ± 0.5 weeks if initial DEM was normal and 40.6 ± 0.8 weeks if initial DEM was abnormal (p<0.01). 10.5% of infants with initial abnormal DEM had untoward outcome (5 ALTE, 1 SIDS, 3 other hospitalization); 4.8% with initial normal DEM (2 ALTE, 5 other hospitalizations). The sensitivity, specificity, and positive predictive value of the initial DEM for untoward outcome are 56.0%, 35.5%, and 10.6%, respectively.

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Conclusion: A DEM in healthy premature infants at time of discharge is not useful in screening for pathologic apnea or bradycardia regardless of gestational age. Younger GA infants are more likely to have abnormal events on initial and follow-up DEM recordings. A DEM at the time of discharge may be useful in predicting duration of home monitoring.