Home Monitoring for the Sudden Infant Death Syndrome

Home monitoring has become popular for management of infants who are perceived to be at increased risk for the Sudden Infant Death Syndrome (SIDS). It is frequently recommended for infants with unexplained apnea of infancy, for subsequent siblings of SIDS, and for premature infants with apnea. This paper will explore the appropriateness, the effectiveness, and the risk of home monitoring for these infants. A discussion of home monitoring for infants with bronchopulmonary dysplasia (BPD), neurologic disorders, and other pathology is beyond the scope of this paper. The American Academy of Pediatrics has issued two statements concerning SIDS and home monitoring. The first, which responded to over-the-counter sales of monitors, discouraged their use except as a research tool.’ The second, a response to the growing clinical use of home monitors for infants with apnea, made no firm recommendations but did advocate 24 hour surveillance for infants who had had one or more episodes of prolonged apnea.* Prolonged apnea was defined as “cessation of breathing for 20 seconds or longer, or as a briefer episode associated with bradycardia, cyanosis, or pallor.” Unfortunately, the abnormality of brief apneic episodes associated with bradycardia was neither then nor later established. This definition has resulted in attributing pathological significance to entirely normal patterns. Recently, the National Institutes of Health sponsored a “Consensus Statement on Infantile Apnea and Home M~nitor ing.”~ Both the advocates for and against monitoring were sensibly excluded from the conference which produced this consensus statement. The statement, which is long and carefully thought out, covers types of infants at risk, safety of monitors, evidence for their effectiveness and recommendations for their use, and avenues for further research. It concluded that the infant who had an apparent life-threatening event (ALTE) should benefit from home monitoring but that there is insufficient evidence to recommend monitoring in other groups for which it has been advocated. It stated, “The effectiveness of home monitoring in reducing infant mortality and morbidity is not yet established.”

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