...back to contents
ISIDA Logo The Use of Apnoea Monitors at home
 Appendix E

Introduction

The use of home apnoea monitors has evolved on an unstructured basis in Ireland as in most Western countries. There is no scientific evidence to show that current monitors prevent Sudden Infant Death Syndrome (SIDS). While this is suitable for evaluation by a prospective randomised trial, such a large sample size would be needed that a trial appears impracticable. In the meanwhile, public perception and pressure encourage home apnoea monitoring to continue.

The current practice is uneven and monitors may be prescribed for:- normal infants because of parental worry, normal infants where there has been a previous stillbirth, neonatal death, or SIDS,
low birthweight infants with or without apnoea or other complications, infants who have had a cyanotic spell, infants who have had a previous apparent life threatening episode (ALTE) ("so called near miss cot-death").

Monitoring may not be justified in all of these situations.

Below are SIDS rates per 1000 live births for various groups of babies (see reference 1):
All infants
Siblings of SIDS
Very low birthweight infants
Bronchopulmonary dysplasia
ALTE x 1
ALTE x 2		 1.0
8.0
5.0-10.0
10.0
40.0-80.0
200.0-280.0

An ALTE should only be diagnosed where a severe episode requiring vigorous resuscitation has occurred, particularly during sleep, with the infant clinically normal subsequently and the event unexplained. Guntheroth (see reference 2) described it as an episode in which death seemed imminent.

Where possible, an ALTE should be distinguished from a seizure, syncopal episode or aspiration by the history. Important observations include whether the child was asleep or awake, cyanosed or pale, limp or stiff, gagging or apnoeic.

Who should get a monitor?
Recommendations:
  1. Severe ALTE
  2. SIDS sibling if more than one SIDS
  3. SIDS sibling if parents request monitor to relieve anxiety
  4. Bronchopulmonary dysplasia
  5. Birthweight <1000g if parents request monitor to relieve anxiety
  6. Central hypoventilation
Non-indications:
Neither apnoea nor prematurity if resolved nor an abnormal pneumogram are risk factors for SIDS. A previous stillbirth or a neonatal death are not indications for home monitoring.

Practical Aspects:
It is essential to instruct on monitor management and resuscitation technique. Ready emergency access to hospital facilities where there is experience in infant care and the use of monitors in the home is most important. There should be follow-up to provide support for the family. Monitoring could cease at 8-9 months or 2 months after the last ALTE.

References
  1. Oren J, Kelly D, Shannon DC. Identification of a high risk group for Sudden Infant Death Syndrome among infants who were resuscitated for sleep apnoea. Paediatrics 1986;77:495-499.
  2. Guntheroth WG. In: Bergman AB, Beckwith JB, Ray CB, eds. Sudden Infant Death Syndrome. Seattle. University of Washington Press, 1970:199.

Relevant Reviews:

  1. Apnoea monitors and Sudden Infant Death. Report from the Foundation for the Study of Infant Death and the British Paediatric Respiratory Group. Archives of Disease in Childhood 1985:60:76-80.
  2. National Institute of Health Consensus Development Conference on Infantile Apnoea and Home Monitoring September 29 to October 1, 1968. Paediatrics 1987:79:292-299
  3. Home monitoring for infantile apnoea. Editorial Lancet 1987;ii:140-141.
  4. Monitoring and Sudden Infant Death Syndrome: an update. Report from the foundation for the study of Infant Death and the British Paediatric Respiratory Group. Archives of Disease in Childhood 1990:60:238-240.





Dr. T Matthews (Governor), Dr. R. Counahan, Dr. W. Gorman. Faculty of Paediatrics, Royal Academy of Medicine in Ireland. 10.12.93
...back to contents