Predischarge monitoring of preterm infants

Abstract

The objectives of this study were: 1) to perform documented event‐monitoring (DEM) for apnea (A, ⩾20 s) and bradycardia (B, <80 beats per min for ⩾5 s) in premature infants prior to discharge, and 2) to examine the accuracy of nursing documentation (ND) of A and B. Forty‐four stable preterm infants, with mean weights and gestational ages at birth (± SD) of 1,543 (± 365) g, and 30 (± 2) weeks, respectively, were studied using DEM for 9 (± 2) days prior to discharge. Differences in DEM and ND were analyzed by the z‐test for proportions. There were 561 true events recorded by DEM: 56 were As and 505 were Bs. ND revealed 296 events, 190 As and 106 Bs. Of the 56 true As on DEM, only 21 (38%) were correctly reported by ND (P < 0.001, 95% confidence interval (CI) 0.44–0.81). Of the 505 true Bs on DEM, 153 (30%) were correctly reported by ND (P < 0.001, CI 0.63–0.76). When ND was compared with DEM, 174 (59%) of NDs were true events. Of the 106 As on ND, only 21 (20%) were true As on DEM (P < 0.001, CI 0.58–1). Of the 190 Bs on ND, 153 (80%) were true Bs on DEM (P < 0.001, CI 0.13–0.26). ND did not detect 6 of the 33 infants who had significant events on DEM, while 4 of the 11 who had events reported on ND did not have any on DEM. Thus, 10 infants were misclassified by ND (P < 0.01, CI 0.1–0.36). These results indicate that, compared to DEM, ND not only identified significantly fewer true As and Bs, but also misclassified a significant number of infants. We conclude that DEM performed prior to discharge for preterm infants at risk for apnea and bradycardia provides more objective and accurate information than ND. Pediatr Pulmonol. 1999; 27:113–116. © 1999 Wiley‐Liss, Inc.

A comparison of the infant car seat challenge and the polysomnogram at the time of hospital discharge

“…In addition, while our 12–24 h PSG provided more physiological data than the 1 h ICSC, it is possible that more significant events would have been documented with an even longer period of monitoring as shown by Razi et al 20. In contradistinction to our study, which was performed under standard clinical conditions in a busy Neonatal Intensive Care Unit with event recording monitors and the infant's nurse responsible for documenting events, Elder et al 14 were able to gather much more data through the use of a dedicated paediatric sleep technician.…”

Effect of Supplemental Oxygen on Sleep Architecture and Cardiorespiratory Events in Preterm Infants

“…13 Although some infants may become symptomatic, several studies have pointed out that a large percentage of apnea and bradycardia will not be detected by the nursing staff. 14,15 Furthermore, clinical observation alone not only identified significantly less true apnea and bradycardia but also substantially misclassified the type of apnea in these infants. 15 The present study further substantiates these findings, particularly because infants who were enrolled in this study were reported as asymptomatic by the nursing staff, whereas the overnight polysomnographic evaluation revealed significant apnea and bradycardia.…”

“…14,15 Furthermore, clinical observation alone not only identified significantly less true apnea and bradycardia but also substantially misclassified the type of apnea in these infants. 15 The present study further substantiates these findings, particularly because infants who were enrolled in this study were reported as asymptomatic by the nursing staff, whereas the overnight polysomnographic evaluation revealed significant apnea and bradycardia. Stebbens et al 16 showed that preterm infants have baseline values of oxyhemoglobin saturation in the same range as those of full-term infants and that punctual measurements may not provide reliable information.…”

Under-recognition of alarms in a neonatal intensive care unit

“…In another study, nursing staff often did not respond directly to alarms, but, rather, used them as an additional source of information 12. Razi et al ,13 however, showed that 36% of nursing staff's alarm registry showed no objective correlate.…”