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.

• Sudden infant death syndrome (SIDS)
• Apnea of prematurity
• Apnea and/or bradycardia of infancy

Prevention
Risk Assessment

Family Practice
Pediatrics
Preventive Medicine

Physicians

To provide recommendations regarding the appropriate use of home cardiorespiratory monitoring after hospital discharge in at-risk newborns

• 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

Home cardiorespiratory monitoring

• Efficacy of home cardiorespiratory monitoring
• Incidence of sudden infant death syndrome (SIDS)
• Risk of sudden infant death syndrome

Searches of Electronic Databases

Not stated

Not stated

Not stated

Not applicable

Review

Not stated

Expert Consensus

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Peer Review

Not stated

1. Home cardiorespiratory monitoring should not be prescribed to prevent sudden infant death syndrome (SIDS).
2. 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.
3. 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.
4. If home cardiorespiratory monitoring is prescribed, the monitor should be equipped with an event recorder.
5. Parents should be advised that home cardiorespiratory monitoring has not been proven to prevent sudden unexpected deaths in infants.
6. 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.

None provided

The type of supporting evidence is not specifically stated for each recommendation.

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

Not stated

An implementation strategy was not provided.

Staying Healthy

Effectiveness

Not applicable: The guideline was not adapted from another source.

2003 Apr

American Academy of Pediatrics - Medical Specialty Society

American Academy of Pediatrics

Committee on Fetus and Newborn

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

Not stated

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.

None available

None available

This NGC summary was completed by ECRI on August 18, 2003. The information was verified by the guideline developer on September 8, 2003.

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.