Article
Pre-Discharge Event Recording in Infants with Resolving Apnea of Prematurity (AOP) Treated with Caffeine Citrate
Pediatric Research
(1999)
Abstract
AOP is a common diagnosis in premature infants with an 85% incidence in infants less than 34 weeks gestational age. Discharge planning for infants with AOP in a safe and expedient manner is a challenge faced by neonatologists. Smith and Hoy reported a positive correlation between a pre-discharge event recording (PDER) performed for one week and continued events at home (Pediatr Res Abs, 1993). We sought to determine whether a 24-hour PDER could accurately identify a group of infants at greater risk for adverse outcome. The medical records of all infants treated with caffeine citrate at the time of hospital discharge from January 1995 to December 1996 were reviewed. Prior to discharge all infants were placed on a 24-hour event recording monitor to capture central apneas ≥10 seconds and heart rates ≤90 beats per minute. The PDER was analyzed to determine whether infants had prolonged apneas or bradycardias at rest or whether their respiratory pattern appeared mature. An abnormal PDER was defined as apneas ≥20 seconds or bradycardia of <80 BPM for 5 seconds at rest. A normal PDER was defined as no apneas ≥20 seconds or bradycardias. To determine the frequency of post-discharge complications over the first year of life, parents were contacted by mail or phone. The primary outcome measure of post-discharge complications were apnea-related emergency room visits, re-hospitalization, ALTE or death. Of the 418 patients referred to the Infant Apnea Program during that period, 79 infants were identified as ready for discharge with a diagnosis of resolving AOP and treated with caffeine citrate. Fifty-five of the 79 infants had a normal event recording while 24 had an abnormal recording (apneas ≥20 seconds and/or heart rate <80 BPM ≥5 seconds). Birth weight, gestational age at birth, length of stay, discharge weight, and duration of caffeine treatment after discharge were no different between the two groups. The primary outcome variables of death, ALTE, apnea-related re-hospitalization and emergency room visit for the normal PDER group were 0/55 vs 4/24 for the abnormal PDER group (p < 0.05). The positive predictive value of a normal PDER and no post-discharge complication was 100%. We conclude that: (1) PDER for as short as 24-hours can predict which infants are more likely to continue to have events at home after discharge. (2) A normal PDER in infants with resolving AOP correlates with a low risk of adverse outcome. (3) 24-hour PDER of preterm infants treated with caffeine citrate for resolving AOP can identify a sub-population of infants at greater risk for adverse outcome. We speculate that maintenance of therapeutic caffeine levels after discharge with closer follow up of infants with an abnormal PDER may decrease post-discharge complications.
Disciplines
Publication Date
April, 1999
Citation Information
Muhammad Subhani, Susan Katz and Joseph D DeCristofaro. "Pre-Discharge Event Recording in Infants with Resolving Apnea of Prematurity (AOP) Treated with Caffeine Citrate" Pediatric Research Vol. 45 (1999) p. 256 Available at: http://works.bepress.com/susan-katz/6/