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Neonatal Respiratory Assessment/Support/Ventilation

Neonatal Respiratory Assessment/Support/Ventilation 3: Physiology 2 and Clinical Outcomes

349 - Methods for monitoring and definitions of apneas in preterm infants: a scoping review

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 349
Publication Number: 349.346

Emily M. Jeanne, Faculty of Medicine and Health Sciences, Division of Experimental Medicine, McGill University, Montreal, QC, Canada, Montreal, PQ, Canada; Shasha Lv, McGill University Health Center – Research Institute, McGill University, Montreal, QC, Canada, Montreal, PQ, Canada; Eva B. Senechal, aculty of Medicine and Health Sciences, Division of Experimental Medicine, McGill University, Montréal, PQ, Canada; Tugba Alarcon Martinez, McGill University Faculty of Medicine and Health Sciences, Montreal, PQ, Canada; Lydia Tao, McGill University Health Center – Research Institute, McGill University, Montreal, QC, Canada, Montreal, PQ, Canada; Debra E. Weese-Mayer, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Guilherme Sant'Anna, McGill University Health Center, MONTREAL, PQ, Canada; Wissam Shalish, Division of Neonatology, Montreal Children’s Hospital, McGill University Health Center, Montreal, Quebec, Canada, Montreal, PQ, Canada

Presenting Author(s)

Emily M. Jeanne (she/her/hers)

M.Sc. Candidate
McGill University, Faculty of Medicine and Health Sciences Montreal, Quebec, Canada
Montreal, Quebec, Canada

Background: Apneas are ubiquitous in preterm infants and are associated with complications. Adequate detection and differentiation between central, obstructive, and mixed apneas requires simultaneous monitoring of respiratory efforts and airflow. However, apnea monitoring practices and definitions remain unstandardized.

Objective: To describe the clinical methods used to monitor apneas and definitions employed in preterm infants hospitalized or recently discharged from the NICU.

Design/Methods:

In this scoping review, MEDLINE, Embase, Web of Science, and Cochrane Library were systematically searched. Studies published between 01/2000 and 12/2021 involving continuous physiological monitoring of apneas during NICU hospitalization or within 4 weeks from NICU discharge amongst infants < 37 weeks’ gestation were included. Study characteristics, devices employed for apnea detection and their respective accuracies, and apnea definitions were described.

Results: 148 studies were included (Table 1). Monitoring was mostly done during hospitalization (n=117, 79%), for a median duration of 6h (IQR 3-11h). Eleven distinct devices were employed to monitor respiratory effort, with the most common being respiratory inductance plethysmography (n=60), transthoracic impedance (n=50), and piezoelectric sensors (n=13) (Fig 1). Conversely, 7 different devices were used to monitor airflow, with oronasal thermal devices (n=63), nasal pressure transducers (n=34), and capnography (n=16) the most common. Accuracy in detecting central apneas was mostly evaluated by transthoracic impedance (n=10), demonstrating sensitivities ranging from 9% (used alone) to 95% (used with an algorithm filtering the integrated bedside signals). Sensitivities in detecting obstructive apneas were reported as: nasal pressure transducers = 95%, diaphragm electromyography = 56%, respiratory inductive plethysmography = 53%, oronasal thermal device = 44%, and transthoracic impedance = 33%. Apnea definitions were heterogeneous, using variable durations of breathing cessation (median 10s, IQR 5-20s) and not consistently including the co-occurrence of bradycardias and/or oxygen desaturations (n=48 studies, 33%) of variable durations and severity thresholds (Fig 2).

Conclusion(s): There is significant variability in the clinical methods used to monitor apneas and definitions employed in the current literature, making it difficult to draw robust conclusions. Enhanced methods for monitoring apneas (especially obstructive types) as well as standardized guidelines for defining apneas in preterm infants are urgently needed.