Cardiorespiratory Events Recorded on Home Monitors: Comparison of Healthy Infants With Those at Increased Risk for SIDS

• Published in: JAMA : the journal of the American Medical Association Vol. 285; no. 17; pp. 2199 - 2207
• Main Authors: Ramanathan, Rangasamy, Corwin, Michael J, Hunt, Carl E, Lister, George, Tinsley, Larry R, Baird, Terry, Silvestri, Jean M, Crowell, David H, Hufford, David, Martin, Richard J, Neuman, Michael R, Weese-Mayer, Debra E, Cupples, L. Adrienne, Peucker, Mark, Willinger, Marian, Keens, Thomas G
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Medical Association 02-05-2001
• Subjects: Airway Obstruction - diagnosis; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Apnea - diagnosis; Babies; Biological and medical sciences; Bradycardia - diagnosis; Comparative analysis; Electronic monitoring; Emergency and intensive respiratory care; Health risk assessment; Home Nursing; Humans; Infant; Infant, Newborn; Infant, Premature; Intensive care medicine; Longitudinal Studies; Medical sciences; Monitoring, Physiologic - instrumentation; Plethysmography; Proportional Hazards Models; Respiration Disorders - diagnosis; Risk Factors; SIDS; Sudden Infant Death - prevention & control; Sudden infant death syndrome; Survival Analysis; Human; Premature; Pediatrics; High risk; Respiratory disease; Sudden death; Cardiovascular disease; Infant; Asymptomatic; Sibling; Cardiorespiratory control; Monitor; Cohort study; Comparative study
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.285.17.2199

CONTEXT: Home monitors designed to identify cardiorespiratory events are frequently used in infants at increased risk for sudden infant death syndrome (SIDS), but the efficacy of such devices for this use is unproven. OBJECTIVE: To test the hypothesis that preterm infants, siblings of infants who died of SIDS, and infants who have experienced an idiopathic, apparent life-threatening event have a greater risk of cardiorespiratory events than healthy term infants. DESIGN: Longitudinal cohort study conducted from May 1994 through February 1998. SETTING: Five metropolitan medical centers in the United States. PARTICIPANTS: A total of 1079 infants (classified as healthy term infants and 6 groups of those at risk for SIDS) who, during the first 6 months after birth, were observed with home cardiorespiratory monitors using respiratory inductance plethysmography to detect apnea and obstructed breathing. MAIN OUTCOME MEASURES: Occurrence of cardiorespiratory events that exceeded predefined conventional and extreme thresholds as recorded by the monitors. RESULTS: During 718 358 hours of home monitoring, 6993 events exceeding conventional alarm thresholds occurred in 445 infants (41%). Of these, 653 were extreme events in 116 infants (10%), and of those events with apnea, 70% included at least 3 obstructed breaths. The frequency of at least 1 extreme event was similar in term infants in all groups, but preterm infants were at increased risk of extreme events until 43 weeks' postconceptional age. CONCLUSIONS: In this study, conventional events are quite common, even in healthy term infants. Extreme events were common only in preterm infants, and their timing suggests that they are not likely to be immediate precursors to SIDS. The high frequency of obstructed breathing in study participants would likely preclude detection of many events by conventional techniques. These data should be important for designing future monitors and determining if an infant is likely to be at risk for a cardiorespiratory event.