Use of home cardiorespiratory monitors in infants
- Michael J Corwin, MD
Michael J Corwin, MD
- Associate Professor of Pediatrics and Epidemiology
- Boston University Schools of Medicine and Public Health
- Section Editors
- George B Mallory, MD
George B Mallory, MD
- Section Editor — Pediatric Pulmonology
- Associate Professor of Pediatrics
- Baylor College of Medicine
- Leonard E Weisman, MD
Leonard E Weisman, MD
- Section Editor — Neonatology
- Professor of Pediatrics
- Baylor College of Medicine
Home cardiorespiratory (CR) monitors have been available for approximately 30 years, and were originally intended to prevent sudden infant death syndrome (SIDS) in at-risk infants. Since then, it has become clear that the CR monitor is not an effective tool to prevent SIDS.
Nonetheless, there is some justification for the use of CR monitors in selected infants with other underlying disorders. Selection of infants for monitoring depends upon the infant's underlying problem and the capabilities of the monitor. In many cases, the primary utility of the monitor is diagnostic (ie, to distinguish genuine from false CR events and document the nature and frequency of CR events) rather than therapeutic (ie, to provide an alarm that allows intervention to terminate events).
The appropriate use of CR monitors for specific disorders, the capabilities and limitations of the devices, and the management of infants with CR monitors will be reviewed here. The pathophysiology, evaluation, and other approaches to managing the disorders for which CR monitoring is sometimes considered are discussed separately. (See "Sudden infant death syndrome: Risk factors and risk reduction strategies" and "Acute events in infancy including brief resolved unexplained event (BRUE)" and "Management of apnea of prematurity".)
The use of home cardiorespiratory (CR) monitors has become increasingly controversial. In a 1987 NIH Consensus Statement on Infantile Apnea and Home Monitoring, home CR monitoring was recommended for infants thought to be at-risk for sudden infant death syndrome (SIDS). At that time, at-risk infants were thought to include premature infants with episodic apnea or bradycardia, infants who had experienced one or more severe apparent life threatening events (ALTE), and siblings of two or more SIDS victims. However, the authors of the statement were also careful to point out that "the effectiveness of home monitoring in reducing infant mortality and morbidity is not yet established."
Since the publication of this document, advances in the understanding of the pathophysiology of these disorders, outcomes of clinical trials, and clinical experience have substantially narrowed the indications for CR monitor use. One must also consider the high costs of continuous monitoring, which include the device, training and respite of caretakers, and analysis of recorded events. In addition, concerns have been raised that the use of CR monitors might distract from other established preventive measures (eg, safe sleeping environment for prevention of SIDS), have adverse effects on the parents' quality of life, and present difficulties in determining an end point for monitoring.
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- DEVICES AND CAPABILITIES
- MONITORING DECISIONS
- Asymptomatic infants with risk factors for sudden infant death syndrome
- Preterm infants with persistent symptoms related to apnea of prematurity
- Infants with apparent life-threatening events
- Other indications
- Counseling of parents
- Professional support
- Monitor settings
- End point of monitoring
- SUMMARY AND RECOMMENDATIONS