The following are practical guidelines for apnoea monitoring of neonates being discharged from National Women’s Hospital.

1. There is no evidence that monitoring of infants is of value in saving lives.
2. Apnoea monitors are not designed to detect obstructive apnoea, and will fail to detect obstructive apnoea.
   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.
3. Low birthweight (LBW, VLBW, ELBW) in itself is not an indication for home monitoring.
4. It is not clear that polygraphic studies identify infants at particularly high risk of SIDS.  However, they may be useful in individual cases.
5. Monitoring does not preclude the need in may cases to fully investigate and treat causes of apnoea.
6. Some weeks prior to discharge all infants should be nursed in the supine position unless clinical condition indicates otherwise.
7. Reduction of risk factors for SIDS should be emphasised:
   • supine sleep position
   • no bedding around the head (including no cot bumpers)
   • no overwrapping
   • avoidance of cigarette smoke
   • it is preferable that co-bedding is avoided and the infant is breastfed.

With these points in mind, the following infants should be considered for home apnoea monitoring:

1. Preterm infants with chronic lung disease discharged on home oxygen, or having recently (within the last two weeks) come off oxygen.
2. Where practicable, preterm infants of narcotic and polydrug abusers.  Infants exposed to opioids in utero have a higher risk of SIDS.  Preterm infants may be at increased risk and should be considered for home apnoea monitoring.  Reduction of risk factors for SIDS should be emphasised (that is, supine sleep position, breast feeding, avoidance of cigarette smoke and co-bedding).  
3. Infants who have an Apparent Life Threatening Event (ALTE) in Hospital, with no remediable cause identified.
4. Infants with respiratory obstruction, e.g, infants with Pierre Robin Syndrome, other upper airways anomalies and with abnormalities of tone contributing to feeding and swallowing difficulties.
5. 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.
6. Siblings of infants with SIDS who have additional risk factors such as prematurity, apnoeas, or chronic lung disease.

   • Parents of a previous SIDS victim should be referred, preferably in early pregnancy to the Cot Death Society for counselling. Infants when born can be referred for polygraphic studies but monitoring would not routinely be indicated for these infants.

7. Infants of parents in a state of extreme anxiety where there are contributory factors, e.g. poor obstetric history.

These recommendations are according to the NIH Consensus Development Statement (1986) that monitoring is medically indicated for symptomatic but not asymptomatic preterm infants.  This was reiterated by the CHIME study (JAMA 2001; 285:2199).

Practical Points

1. Polygraphic monitoring may be provided by consultation with Starship Respiratory Team, Dr Carolyn Dakin, in response to Consultant referral. A referral sheet should be completed and placed in the infant’s notes at the same time as the phone call. The monitoring will usually be done at the Starship.  The Respiratory Department anticipates having full sleep monitoring available in the future but currently performs Edentrace respiratory monitoring.
2. 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 Consultant and parents. The Cot Death Society also has monitors, most of which are supplied to infants who have had an ALTE after discharge home. For some anxious parents whose infant does not fit the above criteria and for whom a Hospital monitor cannot be made available, hiring of a monitor from certain Pharmacies may be a satisfactory alternative.
3. 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