Different NICU, different care for premies with sleep apnea
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by Aimee Keenan-Greene
A new study in the journal Pediatrics says the number of preterm infants diagnosed with sleep apnea varies greatly from one neonatal intensive care unit to the next. It is affecting the length of stay for infants and a more standard practice is needed to reduce the length of time in the NICU for all babies.
In a premature baby the part of the central nervous system that controls breathing is not developed enough to produce non-stop breathing. This causes alternating deep inhaling and shallow breathing or stopped breathing for 15-20 seconds, known as apnea of prematurity, or AOP, according to Kids Health. When a baby stops breathing their heart rate drops, causing bradycardia. Those with AOP become pale or bluish and can appear limp. They may require help to restart breathing.
Apnea is one of the most common diagnoses in the NICU. Resolving apnea is usually a requirement for discharge from the hospital, that's why different monitoring practices may affect length of stay for premature infants.
In this latest study, the team of scientists was led by Eric C. Eichenwald, MD, and included John A. F. Zupancic, MD, ScD, Wen-Yang Mao, MS, Douglas K. Richardson, MD, MBA, Marie C. McCormick, MD, and Gabriel J. Escobar, MD.
They compared the proportion of 33 to 34 weeks' gestational age infants diagnosed with apnea in different NICUs to assess whether variability in length of stay would be affected by the rate of documented apnea. They conducted a prospective cohort study of moderately preterm infants discharged from 10 NICU's in California and Massachusetts.
In all 536 infants born between 33 and 34 6/7 weeks were studied. Of them 264, or 49 percent, were diagnosed with apnea. Kids with apnea spent longer in the hospital and there was a variation of almost a week and a half between between NICU discharges. Researchers believe as much as 28 percent of that variability in discharge between NICUs could be explained by the variability in the proportion of infants diagnosed with apnea.
The March of Dimes estimates over half a million babies, about 1 in 8, are born prematurely each year and their medical bills cost ten times more than healthy babies. According to the Preterm Birth: Causes, Consequences and Prevention, a report published by the Institute of Medicine in 2006 and funded in part by the March Of Dimes, the cost of preterm birth in the US was 26.2 billion dollars. That's about $51,600 for every premie.
According to Kids Health, apnea of prematurity usually resolves on its own. It does not cause brain damage. Although sudden infant death syndrome (SIDS) does occur more often in premature infants, no definitive link between AOP and SIDS has been proved.
Sudden Infant Death Syndrome (SIDS) is defined as the sudden death of an infant less than one year of age that cannot be explained after a thorough investigation including complete autopsy, examination of the death scene, and review of the clinical history.
The Centers for Disease Control and Prevention say more than 4,500 infants die suddenly of no obvious cause each year. Half of these Sudden Unexpected Infant Deaths (SUID) are due to Sudden Infant Death Syndrome (SIDS). SIDS is the leading cause of all deaths among infants aged 1–12 months. It is the third leading cause of infant mortality overall in the United States.
Although the overall rate of SIDS in the United States has declined by more than 50 percent since 1990, rates have declined less among non-Hispanic Black and American Indian-Alaska Native infants.
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