Out-patient management of discharge-delaying ABD events in a late preterm and term population was a cost-effective alternative to prolonged in-patient observation.
Apnea, bradycardia, and oxygen desaturation events are a common in neonatal intensive care units, with relevant literature to date largely focusing on very low birth weight and extremely low birth weight infants. We conducted a retrospective review of infants born at ≥34 weeks gestational age at 2 tertiary neonatal intensive care units in Boston, MA, between January 2009 and December 2013. Our objectives included (1) describing the diagnostic evaluations performed in late preterm to term infants with discharge-delaying apnea, bradycardia, or oxygen desaturation events and (2) identifying variables associated with home monitor use. Of the 741 eligible infants identified, diagnostic evaluations were variable and infrequent with blood culture, blood glucose, and head ultrasound performed most commonly. The likelihood of home monitor use was greater in infants with either a prolonged inpatient stay or greater gestational age at birth.
Apnea, bradycardia, and oxygen desaturation (ABD) events together encompass one of the most ubiquitous problems encountered in the neonatal intensive care unit (NICU), with persistent events often resulting in variable lengths of stay. 1 ABD events have been well studied in infants born prior to 34-weeks gestational age (GA), although they also affect 4%e12% of late preterm infants born at >34 0/7 to 36 6/7 weeks GA. 2,3 The clinical significance of immaturityrelated ABD events in the late preterm and full term population is unclear. Intermittent hypoxia has been associated with poor neurodevelopmental outcomes and retinopathy of prematurity in extremely preterm infants. 4 Available data pertaining to late preterm infants is remarkable for a trend toward impaired neurodevelopment, although a relationship to ABD events is not yet been studied. 5 The persistence of ABD events beyond the achievement of other discharge-delaying milestones, especially in a population of near term infants, presents a clinical conundrum for the caregiver team. Moreover, the proportion of late preterm and full term infants, specifically affected by dischargedelaying ABD events, remains unknown.In a 5-year retrospective study, we identified a population of late preterm and full term infants with ABD events as the last discharge-delaying diagnosis. The inclusion criteria included birth at 34 0/7 weeks GA and a documented ABD event within 10 days before the NICU discharge at Beth Israel Deaconess Medical Center (BIDMC) and Brigham and Women's Hospital (BWH) between January 1, 2009 and December 31, 2013. Monitor alarm settings at both institutions were for apnea 20 s, bradycardia 80 beats per minute, and oxygen saturation <90 percent. Infants were excluded if any other diagnosis, such as temperature
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.