Apnoea Monitoring on
Discharge from NICU
Clinical Practice Committee
|All families shall receive
appropriate education in regard to safe sleeping for their baby.
The following are practical guidelines for
apnoea monitoring of neonates being discharged from National Womenís Hospital.
- There is no evidence that monitoring of infants is of value in saving
- Apnoea monitors are not designed to detect obstructive apnoea. Thus,
infants with respiratory obstruction (e.g. Pierre-Robin sequence, upper
airway anomalies, and infants with abnormalities of tone contributing to
feeding and swallowing difficulties) should be treated appropriately as
indicated by the underlying problem.
- Low birthweight (LBW, VLBW, ELBW) in itself is not an indication for
home monitoring but some infants with a difficult NICU course may be
considered for monitoring.
- It is not clear that polygraphic studies identify infants at
particularly high risk of SUDI. However, they may be useful in individual
- Monitoring does not preclude the need appropriately investigate and
treat causes of apnoea.
- Some weeks prior to discharge all infants should be nursed in the supine
position unless clinical condition indicates otherwise.
- Reduction of risk factors for SUDI should be emphasised:
- supine sleep position
- no bedding around the head (including no cot bumpers), face clear
- no overwrapping
- avoidance of cigarette smoke
- no bed sharing
- sleep in same room as a competent caregiver for first 6 months
- breast feed where possible
With these points in mind, the following
infants should be considered for home apnoea monitoring:
- Preterm infants with chronic lung disease discharged on home oxygen, or
having recently (within the last two weeks) come off oxygen.
- Where practicable, preterm infants of narcotic and polydrug abusers.
Infants exposed to opioids in utero have a higher risk of SUDI. Preterm
infants may be at increased risk and should be considered for home apnoea
monitoring. Reduction of risk factors for SUDI should be emphasised (that
is, supine sleep position, breast feeding, avoidance of cigarette smoke and
- Infants who have an Apparent Life Threatening Event (ALTE) in hospital,
with no remediable cause identified.
- Infants with respiratory obstruction or with upper airways anomalies
and/or abnormalities of tone contributing to feeding and swallowing
difficulties should be considered on an individual basis in discussion with
- Some infants with apnoea continuing beyond the normal period of
prematurity, e.g beyond 36 weeks gestation. These infants should be
considered for further investigation (e.g polygraphic and EEG studies) to
determine the cause of apnoea, and some will require monitoring.
- Infants discharged on caffeine treatment for possible hypoventilation
and/or persistent desaturations.
- Siblings of infants with SUDI who have additional risk factors such as
prematurity, apnoeas, or chronic lung disease.
- Parents of a previous SUDI victim should be referred, preferably in
early pregnancy to the sidsandkids.org.nz for counselling. Infants when
born can be referred for polygraphic studies but monitoring would not
routinely be indicated for these infants.
- Polygraphic monitoring may occasionally be provided by consultation with
Starship Respiratory Team, in response to Consultant referral. A referral
sheet should be completed and placed in the infantís notes at the same time
as the phone call.
- The Neonatal Homecare Nursing Service supervise the supply and use of
the monitors available for infants discharged from the Neonatal Unit who fit
the above criteria. Referral should be made after discussion with the
attending Specialist and parents.
- Some anxious parents whose infant does not fit the above criteria and
for whom a hospital monitor cannot be made available, may choose to
privately purchase or hire a monitor (e.g. through sidsandkids.org.nz).
- All parents should attend the cardio-pulmonary resuscitation talks given
by Neonatal Homecare Nurses on the unit prior to discharge.
Click here to read the Information
Sheet for Parents of infants on home apnoea monitoring