Original articles
Home apnea monitor use in preterm infants discharged from newborn intensive care units*

https://doi.org/10.1067/mpd.2001.116280Get rights and content

Abstract

Purpose: To identify current factors associated with home apnea monitor use in preterm infants and to determine whether home monitor use was associated with a shorter length of hospital stay. Setting: We evaluated neonates who were ≤34 weeks’ estimated gestational age and admitted for neonatal intensive care. We excluded neonates with congenital anomalies, neonates transferred out before discharge, and neonates who died. Methods: Using a database created with a computer-assisted tool that generates hospital notes, we reviewed the epidemiology of monitor use. Differences between neonates sent home with an apnea monitor and those who were not were evaluated by using stepwise logistic regression analysis to identify which factors were independently associated with a neonate being discharged with a monitor. Results: We studied 14,532 neonates; 1588 (11%) were sent home with monitors and 12,944 (89%) were not. The most important variables associated with being discharged with a monitor were site of care and a diagnosis of apnea. Site variation remained significant when adjusted for gestational age, diagnosis of apnea, and a history of use of methylxanthines. When corrected for gestational age, monitor use was not associated with shorter hospital stays. Conclusion: The data suggest that monitor use is more dependent on physician preference than medical indication and is not associated with earlier hospital discharge. (J Pediatr 2001;139:245-8)

Section snippets

Study Population

This was a descriptive, cross-sectional, epidemiologic study designed to describe the factors associated with discharge of an infant from the neonatal intensive care unit with a home apnea monitor. Neonates discharged from neonatal intensive care units managed by Pediatrix Medical Group, Inc, between January 1, 1998, and January 31, 2000, who were ≤34 weeks’ estimated gestational age were eligible for inclusion in the study. A total of 18,584 neonates were discharged from 98 neonatal units. We

Results

Eleven percent of infants were sent home with monitors (Table I). Site variation in use of home apnea monitors at discharge ranged from 0% to 57%. Univariate analysis showed that the following factors were associated with increased monitor use: decreasing birth weight and gestational age, white race, being outborn (ie, born at site other than the final site of neonatal care), cesarean delivery, need for assisted ventilation on day 1, a diagnosis of apnea, a history of treatment with

Discussion

We show that site of birth influences monitor use more than any other variable. Other variables that were important included gestational age, birth weight, being outborn, a history of apnea, and a history of treatment with methylxanthines. We did not find an association between monitor use and earlier hospital discharge.

We expected that gestational age would affect monitor use because more immature (and frequently sicker) neonates are more likely to develop problems with apnea and are at higher

Acknowledgements

In addition to the authors, the following physicians participated: K. Lorah (Harrisburg, PA); M. Siriwardena (Utica, NY); E. Otero and C. Smart (Wichita, KS); S. Haskins (Ft Lauderdale, FL); F. Miller (Boca Raton, FL); G. Melnick (Coral Springs, FL); L. Whetstine (Boynton Beach, FL); E. Berman, D. Eichorst, J. Toney, and P. Honeyfield (Denver, CO); R. Rivas, H. Pierantoni, and E. O’Donnell (Houston, TX); K. Zarlengo (Englewood, CO); D. Kanter (West Palm Beach, FL); R. Balcom and E. Bollerup

References (9)

  • UR Kotagal et al.

    Description and evaluation of a program for the early discharge of infants from a neonatal intensive care unit

    J Pediatr

    (1995)
  • RA Darnall et al.

    Margin of safety for discharge after apnea in preterm infants

    Pediatrics

    (1997)
  • American Academy of Pediatrics

    Committee on Fetus and Newborn. Hospital discharge of the high-risk neonate—proposed guidelines. American Academy of Pediatrics. Committee on Fetus and Newborn

    Pediatrics

    (1998)
  • TA Merritt et al.

    A review of guidelines for the discharge of premature infants: opportunities for improving cost effectiveness

    J Perinatol

    (1998)
There are more references available in the full text version of this article.

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*

Reprint requests: Reese H. Clark, MD, Director of Research, Pediatrix Medical Group, Inc, 1301 Concord Terr, Sunrise, FL 33323-2825.

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