Context Home monitors designed to identify cardiorespiratory events are frequently
used in infants at increased risk for sudden infant death syndrome (SIDS),
but the efficacy of such devices for this use is unproven.
Objective To test the hypothesis that preterm infants, siblings of infants who
died of SIDS, and infants who have experienced an idiopathic, apparent life-threatening
event have a greater risk of cardiorespiratory events than healthy term infants.
Design Longitudinal cohort study conducted from May 1994 through February 1998.
Setting Five metropolitan medical centers in the United States.
Participants A total of 1079 infants (classified as healthy term infants and 6 groups
of those at risk for SIDS) who, during the first 6 months after birth, were
observed with home cardiorespiratory monitors using respiratory inductance
plethysmography to detect apnea and obstructed breathing.
Main Outcome Measures Occurrence of cardiorespiratory events that exceeded predefined conventional
and extreme thresholds as recorded by the monitors.
Results During 718 358 hours of home monitoring, 6993 events exceeding
conventional alarm thresholds occurred in 445 infants (41%). Of these, 653
were extreme events in 116 infants (10%), and of those events with apnea,
70% included at least 3 obstructed breaths. The frequency of at least 1 extreme
event was similar in term infants in all groups, but preterm infants were
at increased risk of extreme events until 43 weeks' postconceptional age.
Conclusions In this study, conventional events are quite common, even in healthy
term infants. Extreme events were common only in preterm infants, and their
timing suggests that they are not likely to be immediate precursors to SIDS.
The high frequency of obstructed breathing in study participants would likely
preclude detection of many events by conventional techniques. These data should
be important for designing future monitors and determining if an infant is
likely to be at risk for a cardiorespiratory event.