Abstract â–¡ 59

About 25 percent of all infants born preterm exhibit apnea of prematurity (AOP). Because some preterm infants who are ready for discharge may continue to have apneas, cardiorespiratory home monitoring (HM) has been utilized as an alternative to prolonged hospitalization after the infants have met all other criteria for hospital discharge. This study investigates the natural history of AOP in healthy preterm infants with HM and provides recommendations for the length of time HM is required

Design and Patients: Sixty-four healthy and stable preterm infants with continued AOP discharged with HM were prospectively followed. Criteria for inclusion in the study were: 1) infant ready for discharge, 2) infant clinically stable, 3) Continued AOP. The parents were trained to record for each monitor alarm the occurrence of apnea (> 20 seconds), bradycardia (< 80 beats/minute) or color change, and the type of assistance provided: none, mild tactile stimulation, significant tactile stimulation or CPR.

Results: Mean gestational week at birth was 28.8 (26-34), mean birth weight 1180 gm (730-2390). None of the infants died at home during or after the monitoring period. Parents of 61/64 infants (95%) reported a total of 185 true AOP with an average of 3 events per infant (range: 1-12). Of these, 99 events (54%) in 36 infants (57%) resolved spontaneously without tactile stimulation, 76 events (41%) in 16 infants (25%) responded to mild stimulation, and 9 infants (14%) (10 episodes) responded only to severe stimulation or mouth-to-mouth breathing. The mean postconceptional age of the last documented apnea was 41.03 weeks ranging from 37 to 44 (Fig.). In 80%, AOP terminated between 40 and 44 postconceptional weeks. There was no correlation between the degree of prematurity and the postconceptional age of the last apnea.

figure 1

Conclusions: In healthy preterm infants with AOP discharged with HM, HM may discontinued at 45 post-gestational age because AOP are unlikely to occur beyond that age.