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NICU guideline identifier

Apnoea monitoring on discharge from Newborn Services

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All families to be given appropriate education on safe sleeping for their baby

Overview

  • There is no evidence that monitoring of infants is of value in saving lives. 
  • Apnoea monitors are not designed to detect obstructive apnoea. Thus, infants with respiratory obstruction (e.g. Pierre-Robin sequence, upper airway anomalies, and infants with abnormalities of tone contributing to feeding and swallowing difficulties) should be treated appropriately as indicated by the underlying problem. 
  • Low birthweight (LBW, VLBW, ELBW) in itself is not an indication for home monitoring but some infants with a difficult NICU course may be considered for monitoring. 
  • It is not clear that polygraphic studies identify infants at particularly high risk of SUDI. However, they may be useful in individual cases. 
  • Monitoring does not preclude the need to appropriately investigate and treat causes of apnoea. 
  • Some weeks prior to discharge all infants should be nursed in the supine position unless clinical condition indicates otherwise. 
  • Reduction of risk factors for SUDI should be emphasised:
    • supine sleep position 
    • no bedding around the head (including no cot bumpers), face clear 
    • no overwrapping 
    • avoidance of cigarette smoke 
    • no bed sharing 
    • sleep in same room as a competent caregiver for first 6 months 
    • breast feed where possible 

Criteria for considering home apnoea monitoring

  • Preterm infants with chronic lung disease discharged on home oxygen, or having recently (within the last two weeks) come off oxygen.
  • Where practicable, preterm infants of narcotic and polydrug abusers. Infants exposed to opioids in utero have a higher risk of SUDI. Preterm infants may be at increased risk and should be considered for home apnoea monitoring. Reduction of risk factors for SUDI should be emphasised (that is, supine sleep position, breast feeding, avoidance of cigarette smoke and bed sharing).
  • Infants who have an Apparent Life Threatening Event (ALTE) in hospital, with no remediable cause identified.
  • Infants with respiratory obstruction or with upper airways anomalies and/or abnormalities of tone contributing to feeding and swallowing difficulties should be considered on an individual basis in discussion with the Specialist.
  • Some infants with apnoea continuing beyond the normal period of prematurity, e.g beyond 36 weeks gestation. These infants should be considered for further investigation (e.g polygraphic and EEG studies) to determine the cause of apnoea, and some will require monitoring.
  • Infants discharged on caffeine treatment for possible hypoventilation and/or persistent desaturations.
  • Siblings of infants with SUDI who have additional risk factors such as prematurity, apnoeas, or chronic lung disease.
    • Parents of a previous SUDI victim should be referred, preferably in early pregnancy to the sidsandkids.org.nz for counselling. Infants when born can be referred for polygraphic studies but monitoring would not routinely be indicated for these infants.

Practical points

  • Polygraphic monitoring may occasionally be provided by consultation with Starship Respiratory Team, in response to Consultant referral. A referral sheet should be completed and placed in the infant's notes at the same time as the phone call.
  • The Neonatal Homecare Nursing Service supervise the supply and use of the monitors available for infants discharged from the Neonatal Unit who fit the above criteria. Referral should be made after discussion with the attending Specialist and parents.
  • Some anxious parents whose infant does not fit the above criteria and for whom a hospital monitor cannot be made available, may choose to privately purchase or hire a monitor (e.g. through sidsandkids.org.nz).
  • All parents should attend the cardio-pulmonary resuscitation talks given by Neonatal Homecare Nurses on the unit prior to discharge.

Information for families

  1. Home Apnoea monitor information for families
  2. Safe sleep resources including:
    1. The kidshealth website
    2. Change for our children have produced the following leaflet on safe sleep essentials:Safe sleep essentials page 1 Safe sleep essentials page The website also has information on pēpi-pods®.
    3. Hapai Te Hauora national SUDI prevention coordination service website. 
    4. Tapuaki website which provides information on pregnancy and parenting, including safe sleep practices, as part of a Well Pacific mother and infant service.

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Document Control

  • Date last published: 31 August 2016
  • Document type: Clinical Guideline
  • Services responsible: Neonatology
  • Owner: Newborn Services Clinical Practice Committee
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years