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Cardiorespiratory Events Recorded on Home Monitors
Comparison of Healthy Infants With Those at Increased Risk for SIDS
Rangasamy Ramanathan, MD;
Michael J. Corwin, MD;
Carl E. Hunt, MD;
George Lister, MD;
Larry R. Tinsley, MD;
Terry Baird, MD;
Jean M. Silvestri, MD;
David H. Crowell, PhD;
David Hufford, MD;
Richard J. Martin, MD;
Michael R. Neuman, PhD,MD;
Debra E. Weese-Mayer, MD;
L. Adrienne Cupples, PhD;
Mark Peucker, BS;
Marian Willinger, PhD;
Thomas G. Keens, MD;
for The Collaborative Home Infant Monitoring Evaluation (CHIME) Study Group
JAMA. 2001;285:2199-2207.
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.
Author Affiliations: Department of Pediatrics and Neonatology, University of Southern California School of Medicine, Women's and Children's Hospital, Good Samaritan Hospital, and Childrens Hospital Los Angeles, Los Angeles, Calif (Drs Ramanathan and Keens); Departments of Pediatrics and Epidemiology and Biostatistics, Boston University Schools of Medicine and Public Health, Boston, Mass (Drs Corwin and Cupples, Mr Peucker); Department of Pediatrics, Medical College of Ohio, Toledo (Drs Hunt and Hufford); Department of Pediatrics, Yale University School of Medicine, New Haven, Conn (Dr Lister); Department of Pediatrics, University of Hawaii at Manoa, Kapiolani Medical Center for Women and Children, Honolulu (Drs Tinsley and Crowell); Department of Pediatrics, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio (Dr Baird); Department of Pediatrics, Rush Medical College of Rush University, Rush Children's Hospital, Chicago, Ill (Drs Silvestri and Weese-Mayer); Department of Pediatrics, Case Western Reserve University, Rainbow Babies and Children's Hospital, Cleveland, Ohio (Drs Baird and Martin); Department of Obstetrics and Gynecology, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio (Dr Neuman); Pregnancy and Perinatology Branch, Center for Research for Mothers and Children, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Md (Dr Willinger). Dr Neuman is now with the Joint Program in Biomedical Engineering, University of Memphis and University of Tennessee, Memphis.
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