Guideline:
Apnea sudden infant death syndrome and home monitoring
Bibliographic Source(s)
- American Academy of Pediatrics. Apnea sudden infant death syndrome and home monitoring. Pediatrics 2003 Apr;111(4 Pt 1):914-7. [35 references] PubMed
Guideline Status
This is the current release of the guideline.
American Academy of Pediatrics (AAP) Policies are reviewed every 3 years by the authoring body at which time a recommendation is made that the policy be retired revised or reaffirmed without change. Until the Board of Directors approves a revision or reaffirmation or retires a statement the current policy remains in effect.
Guideline Category
Prevention
Risk Assessment
Intended Users
Physicians
Guideline Objective(s)
To provide recommendations regarding the appropriate use of home cardiorespiratory monitoring after hospital discharge in at-risk newborns
Target Population
- Newborn through children age 1
- Infants with the following indications:
- Infants who have experienced an apparent life-threatening event (ALTE)
- Infants with tracheostomies or anatomical abnormalities that make them vulnerable to airway compromise
- Infants with neurologic or metabolic disorders affecting respiratory control
- Infants with chronic lung disease (bronchopulmonary dysplasia) especially those requiring supplemental oxygen continuous positive airway pressure or mechanical ventilation
Interventions and Practices Considered
Home cardiorespiratory monitoring
Major Outcomes Considered
- Efficacy of home cardiorespiratory monitoring
- Incidence of sudden infant death syndrome (SIDS)
- Risk of sudden infant death syndrome
Methods Used to Collect/Select Evidence
Searches of Electronic Databases
Description of Methods used to Collect/Select the Evidence
Not stated
Number of Source Documents
Not stated
Methods Used to Assess the Quality and Strength of the Evidence
Not stated
Rating Scheme for the Strength of the Evidence
Not applicable
Methods Used to Analyze the Evidence
Review
Description of the Methods Used to Analyze the Evidence
Not stated
Methods Used to Formulate the Recommendations
Expert Consensus
Rating Scheme for the Strength of the Recommendations
Not applicable
Cost Analysis
A formal cost analysis was not performed and published cost analyses were not reviewed.
Method of Guideline Validation
Peer Review
Description of Method of Guideline Validation
Not stated
Major Recommendations
- Home cardiorespiratory monitoring should not be prescribed to prevent sudden infant death syndrome (SIDS).
- Home cardiorespiratory monitoring may be warranted for premature infants who are at high risk of recurrent episodes of apnea bradycardia and hypoxemia after hospital discharge. The use of home cardiorespiratory monitoring in this population should be limited to approximately 43 weeks’ postmenstrual age or after the cessation of extreme episodes whichever comes last.
- Home cardiorespiratory monitoring may be warranted for infants who are technology dependent (tracheostomy continuous positive airway pressure) have unstable airways have rare medical conditions affecting regulation of breathing or have symptomatic chronic lung disease.
- If home cardiorespiratory monitoring is prescribed the monitor should be equipped with an event recorder.
- Parents should be advised that home cardiorespiratory monitoring has not been proven to prevent sudden unexpected deaths in infants.
- Pediatricians should continue to promote proven practices that decrease the risk of SIDS--supine sleep position safe sleeping environments and elimination of prenatal and postnatal exposure to tobacco smoke.
Clinical Algorithm(s)
None provided
Type of Evidence supporting the Recommendations
The type of supporting evidence is not specifically stated for each recommendation.
Potential Benefits
Home cardiorespiratory monitoring may be justified to allow rapid recognition of apnea airway obstruction respiratory failure interruption of supplemental oxygen supply or failure of mechanical respiratory support. Infants for who these indications may apply include:
- Infants who have experienced an apparent life-threatening event (ALTE)
- Infants with tracheostomies or anatomical abnormalities that make them vulnerable to airway compromise
- Infants with neurologic or metabolic disorders affecting respiratory control
- Infants with chronic lung disease (bronchopulmonary dysplasia) especially those requiring supplemental oxygen continuous positive airway pressure or mechanical ventilation
Potential Harms
Not stated
Description of Implementation Strategy
An implementation strategy was not provided.
IOM Care Need
Staying Healthy
IOM Domain
Effectiveness
Bibliographic Source(s)
- American Academy of Pediatrics. Apnea sudden infant death syndrome and home monitoring. Pediatrics 2003 Apr;111(4 Pt 1):914-7. [35 references] PubMed
Adaptation
Not applicable: The guideline was not adapted from another source.
Source(s) of Funding
American Academy of Pediatrics
Guideline Committee
Committee on Fetus and Newborn
Composition of Group that Authored the Guideline
Committee on Fetus and Newborn 2002-2003: Lillian R. Blackmon MD (Chairperson); Daniel G. Batton MD; Edward F. Bell MD; William A. Engle MD; William P. Kanto Jr MD; Gilbert I. Martin MD; Warren N. Rosenfeld MD; Ann R. Stark MD
*James A. Lemons MD (Past Committee Chairperson)
Liaisons: Keith J. Barrington MD; Jenny Ecord MS RNC NNP PNP; Laura E. Riley MD; Kay M. Tomashek MD; Linda L. Wright MD
Staff: Jim Couto MA
*Lead author
Financial Disclosures/Conflicts of Interest
Not stated
Guideline Status
This is the current release of the guideline.
American Academy of Pediatrics (AAP) Policies are reviewed every 3 years by the authoring body at which time a recommendation is made that the policy be retired revised or reaffirmed without change. Until the Board of Directors approves a revision or reaffirmation or retires a statement the current policy remains in effect.
Guideline Availability
Electronic copies: Available from the American Academy of Pediatrics (AAP) Policy Web site.
Print copies: Available from American Academy of Pediatrics 141 Northwest Point Blvd. P.O. Box 927 Elk Grove Village IL 60009-0927.
Availability of Companion Documents
None available
Patient Resources
None available
NGC STATUS
This NGC summary was completed by ECRI on August 18 2003. The information was verified by the guideline developer on September 8 2003.
COPYRIGHT STATEMENT
This NGC summary is based on the original guideline which is subject to the guideline developer's copyright restrictions. Please contact the Permissions Editor American Academy of Pediatrics (AAP) 141 Northwest Point Blvd Elk Grove Village IL 60007.
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