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.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Hunt CE, Corwin MJ, Lister G, et al. Precursors of cardiorespiratory events in infants detected by home memory monitor. Pediatr Pulmonol 2008; 43:87.
- Willinger M, James LS, Catz C. Defining the sudden infant death syndrome (SIDS): deliberations of an expert panel convened by the National Institute of Child Health and Human Development. Pediatr Pathol 1991; 11:677.
- Steinschneider A. Prolonged apnea and the sudden infant death syndrome: clinical and laboratory observations. Pediatrics 1972; 50:646.
- Kelly DH, Pathak A, Meny R. Sudden severe bradycardia in infancy. Pediatr Pulmonol 1991; 10:199.
- Meny RG, Carroll JL, Carbone MT, Kelly DH. Cardiorespiratory recordings from infants dying suddenly and unexpectedly at home. Pediatrics 1994; 93:44.
- Poets CF, Meny RG, Chobanian MR, Bonofiglo RE. Gasping and other cardiorespiratory patterns during sudden infant deaths. Pediatr Res 1999; 45:350.
- Poets CF, Samuels MP, Noyes JP, et al. Home event recordings of oxygenation, breathing movements, and heart rate and rhythm in infants with recurrent life-threatening events. J Pediatr 1993; 123:693.
- Poets CF. Assessing oxygenation in healthy infants. J Pediatr 1999; 135:541.
- American Academy of Pediatrics AAP Task Force on Infant Positioning and SIDS: Positioning and SIDS. Pediatrics 1992; 89:1120.
- Changing concepts of sudden infant death syndrome: implications for infant sleeping environment and sleep position. American Academy of Pediatrics. Task Force on Infant Sleep Position and Sudden Infant Death Syndrome. Pediatrics 2000; 105:650.
- Wegman ME. Annual summary of vital statistics--1992. Pediatrics 1993; 92:743.
- Murphy SL, Mathews TJ, Martin JA, et al. Annual Summary of Vital Statistics: 2013-2014. Pediatrics 2017; 139.
- Reece RM. Fatal child abuse and sudden infant death syndrome: a critical diagnostic decision. Pediatrics 1993; 91:423.
- Southall DP, Plunkett MC, Banks MW, et al. Covert video recordings of life-threatening child abuse: lessons for child protection. Pediatrics 1997; 100:735.
- Kairys SW, Alexander RC, Block RW, et al. American Academy of Pediatrics. Committee on Child Abuse and Neglect and Committee on Community Health Services. Investigation and review of unexpected infant and child deaths. Pediatrics 1999; 104:1158.
- American Academy of Pediatrics, Hymel KP, Committee on Child Abuse and Neglect, National Association of Medical Examiners. Distinguishing sudden infant death syndrome from child abuse fatalities. Pediatrics 2006; 118:421 (reaffirmed 2017).
- Firstman R, Talan J. The Death of Innocents, Bantam Books, New York 1997.
- Ward SL, Keens TG, Chan LS, et al. Sudden infant death syndrome in infants evaluated by apnea programs in California. Pediatrics 1986; 77:451.
- MacKay M, Abreu e Silva FA, MacFadyen UM, et al. Home monitoring for central apnoea. Arch Dis Child 1984; 59:136.
- Ramanathan R, Corwin MJ, Hunt CE, et al. Cardiorespiratory events recorded on home monitors: Comparison of healthy infants with those at increased risk for SIDS. JAMA 2001; 285:2199.
- National Institutes of Health Consensus Development Conference on Infantile Apnea and Home Monitoring, Sept 29 to Oct 1, 1986. Pediatrics 1987; 79:292.
- Hunt CE, Corwin MJ, Lister G, et al. Longitudinal assessment of hemoglobin oxygen saturation in healthy infants during the first 6 months of age. Collaborative Home Infant Monitoring Evaluation (CHIME) Study Group. J Pediatr 1999; 135:580.
- Samuels MP, Poets CF, Southall DP. Abnormal hypoxemia after life-threatening events in infants born before term. J Pediatr 1994; 125:441.
- Naulaers G, Daniels H, Allegaert K, et al. Cardiorespiratory events recorded on home monitors: the effect of prematurity on later serious events. Acta Paediatr 2007; 96:195.
- 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