Margin of Safety for Discharge After Apnea in Preterm Infants

Abstract

We conclude that otherwise healthy preterm infants continue to have apneas separated by as many as 8 days before the last apnea before discharge. Conversely, infants with longer apnea intervals often have identifiable risk factors other than apnea of prematurity.

Epidemiology of Apnea and Bradycardia Resolution in Premature Infants

“…Clinicians typically assess this maturation through clinical observation of infants in the hospital, the times for which can range from 1 to 21 days. 6 However, many of these observation times are the same regardless of the characteristics of the infant or when this observation period occurs. Our study of more than 1400 premature infants suggests that a large number of infants do not have future apnea or bradycardia events once they are otherwise ready for discharge on the basis of other physiologic characteristics.…”

“…Much of the earlier work on the epidemiology of apnea and bradycardia within premature infants centers on the effect of gestational age on the timing of the last apnea or bradycardia event. Darnall et al 6 examined 91 infants with a gestational age of less than 32 weeks who were born between 1992 and 1993. These infants had their last apnea event at an average PMA of 37.7 Ϯ 0.3 weeks.…”

“…Short, spontaneously resolving events may have been missed if the nurse was distracted when the event occurred. 21 Previous studies 2,4,6,20 have used a similar datacollection methodology. Nursing records should, however, capture all events that required respiratory intervention by a health care provider.…”

“…Thus, most NICUs have adopted empiric protocols mandating a period of in-hospital observation time for apnea and bradycardia around the time of hospital discharge, ranging from 1 to 21 days. 6 This variation occurs because there is limited information about (1) the recurrence of apnea or bradycardia after a specific apneaor bradycardia-free interval, (2) the effect of gestational age and the PMA of the last event on this recurrence rate, and (3) the impact of different definitions of apnea or bradycardia on recurrence rates, specifically differentiating episodes that resolved spontaneously from episodes that required bag-mask ventilation or intubation. The objective of this study was to examine these questions in a cohort of 1403 premature infants by calculating the success rate and event identification rate (EIR) of various apnea-and bradycardia-free intervals around the time of discharge, after accounting for differences in gestational age, PMA of the last event, and the severity of the event.…”

Role of Carnitine Supplementation in Apnea of Prematurity: A Systematic Review

“…Monitoring of infants is usually discontinued when they have remained apnea free for 3 to 10 days, the exact duration varying between individual NICUs. 7,8 Carnitine, a quaternary amine synthesized from the amino acid lysine, is essential for the transport of fatty acids across mitochondria membranes for beta-oxidation metabolism and ketone generation. 9 Deficiency of carnitine leads to a decrease in long-chain fatty acids that are available for beta-oxidation, resulting in a decrease in energy production at the muscular level.…”