![](media/image1.png){width="5.96875in" height="0.41944444444444445in"}

Top of Form

## Complete Summary

#### GUIDELINE TITLE

Apnea, sudden infant death syndrome, and home monitoring.

#### BIBLIOGRAPHIC SOURCE(S)

American Academy of Pediatrics. Apnea, sudden infant death syndrome, and
home monitoring. Pediatrics 2003 Apr;111(4 Pt 1):914-7. \[35
references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12671135)

#### GUIDELINE STATUS

This is the current release of the guideline.

American Academy of Pediatrics (AAP) Policies are reviewed every 3 years
by the authoring body, at which time a recommendation is made that the
policy be retired, revised, or reaffirmed without change. Until the
Board of Directors approves a revision or reaffirmation, or retires a
statement, the current policy remains in effect.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

-   Sudden infant death syndrome (SIDS)

-   Apnea of prematurity

-   Apnea and/or bradycardia of infancy

#### GUIDELINE CATEGORY

Prevention\
Risk Assessment

#### CLINICAL SPECIALTY

Family Practice\
Pediatrics\
Preventive Medicine

#### INTENDED USERS

Physicians

#### GUIDELINE OBJECTIVE(S)

To provide recommendations regarding the appropriate use of home
cardiorespiratory monitoring after hospital discharge in at-risk
newborns

#### TARGET POPULATION

-   Newborn through children age 1

-   Infants with the following indications:

    -   Infants who have experienced an apparent life-threatening event
        (ALTE)

    -   Infants with tracheostomies or anatomical abnormalities that
        make them vulnerable to airway compromise

    -   Infants with neurologic or metabolic disorders affecting
        respiratory control

    -   Infants with chronic lung disease (bronchopulmonary dysplasia),
        especially those requiring supplemental oxygen, continuous
        positive airway pressure, or mechanical ventilation

#### INTERVENTIONS AND PRACTICES CONSIDERED

Home cardiorespiratory monitoring

#### MAJOR OUTCOMES CONSIDERED

-   Efficacy of home cardiorespiratory monitoring

-   Incidence of sudden infant death syndrome (SIDS)

-   Risk of sudden infant death syndrome

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

Not stated

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not applicable

#### METHODS USED TO ANALYZE THE EVIDENCE

Review

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Not stated

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

Not stated

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

1.  Home cardiorespiratory monitoring should not be prescribed to
    prevent sudden infant death syndrome (SIDS).

2.  Home cardiorespiratory monitoring may be warranted for premature
    infants who are at high risk of recurrent episodes of apnea,
    bradycardia, and hypoxemia after hospital discharge. The use of home
    cardiorespiratory monitoring in this population should be limited to
    approximately 43 weeks´ postmenstrual age or after the cessation of
    extreme episodes, whichever comes last.

3.  Home cardiorespiratory monitoring may be warranted for infants who
    are technology dependent (tracheostomy, continuous positive airway
    pressure), have unstable airways, have rare medical conditions
    affecting regulation of breathing, or have symptomatic chronic lung
    disease.

4.  If home cardiorespiratory monitoring is prescribed, the monitor
    should be equipped with an event recorder.

5.  Parents should be advised that home cardiorespiratory monitoring has
    not been proven to prevent sudden unexpected deaths in infants.

6.  Pediatricians should continue to promote proven practices that
    decrease the risk of SIDS\--supine sleep position, safe sleeping
    environments, and elimination of prenatal and postnatal exposure to
    tobacco smoke.

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of supporting evidence is not specifically stated for each
recommendation.

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

Home cardiorespiratory monitoring may be justified to allow rapid
recognition of apnea, airway obstruction, respiratory failure,
interruption of supplemental oxygen supply, or failure of mechanical
respiratory support. Infants for who these indications may apply
include:

-   Infants who have experienced an apparent life-threatening event
    (ALTE)

-   Infants with tracheostomies or anatomical abnormalities that make
    them vulnerable to airway compromise

-   Infants with neurologic or metabolic disorders affecting respiratory
    control

-   Infants with chronic lung disease (bronchopulmonary dysplasia),
    especially those requiring supplemental oxygen, continuous positive
    airway pressure, or mechanical ventilation

#### POTENTIAL HARMS

Not stated

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Staying Healthy

#### IOM DOMAIN

Effectiveness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

American Academy of Pediatrics. Apnea, sudden infant death syndrome, and
home monitoring. Pediatrics 2003 Apr;111(4 Pt 1):914-7. \[35
references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12671135)

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

2003 Apr

#### GUIDELINE DEVELOPER(S)

American Academy of Pediatrics - Medical Specialty Society

#### SOURCE(S) OF FUNDING

American Academy of Pediatrics

#### GUIDELINE COMMITTEE

Committee on Fetus and Newborn

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Committee on Fetus and Newborn, 2002-2003*: Lillian R. Blackmon, MD
(Chairperson); Daniel G. Batton, MD; Edward F. Bell, MD; William A.
Engle, MD; William P. Kanto, Jr, MD; Gilbert I. Martin, MD; Warren N.
Rosenfeld, MD; Ann R. Stark, MD

\*James A. Lemons, MD (Past Committee Chairperson)

*Liaisons*: Keith J. Barrington, MD; Jenny Ecord, MS, RNC, NNP, PNP;
Laura E. Riley, MD; Kay M. Tomashek, MD; Linda L. Wright, MD

*Staff*: Jim Couto, MA

\*Lead author

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

#### GUIDELINE STATUS

This is the current release of the guideline.

American Academy of Pediatrics (AAP) Policies are reviewed every 3 years
by the authoring body, at which time a recommendation is made that the
policy be retired, revised, or reaffirmed without change. Until the
Board of Directors approves a revision or reaffirmation, or retires a
statement, the current policy remains in effect.

#### GUIDELINE AVAILABILITY

Electronic copies: Available from the [American Academy of Pediatrics
(AAP) Policy Web
site](http://aappolicy.aappublications.org/cgi/content/full/pediatrics;111/4/914).

Print copies: Available from American Academy of Pediatrics, 141
Northwest Point Blvd., P.O. Box 927, Elk Grove Village, IL 60009-0927.

#### AVAILABILITY OF COMPANION DOCUMENTS

None available

#### PATIENT RESOURCES

None available

#### NGC STATUS

This NGC summary was completed by ECRI on August 18, 2003. The
information was verified by the guideline developer on September 8,
2003.

#### COPYRIGHT STATEMENT

This NGC summary is based on the original guideline, which is subject to
the guideline developer\'s copyright restrictions. Please contact the
Permissions Editor, American Academy of Pediatrics (AAP), 141 Northwest
Point Blvd, Elk Grove Village, IL 60007.

### DISCLAIMER

#### NGC DISCLAIMER

The National Guideline Clearinghouse™ (NGC) does not develop, produce,
approve, or endorse the guidelines represented on this site.

All guidelines summarized by NGC and hosted on our site are produced
under the auspices of medical specialty societies, relevant professional
associations, public or private organizations, other government
agencies, health care organizations or plans, and similar entities.

Guidelines represented on the NGC Web site are submitted by guideline
developers, and are screened solely to determine that they meet the NGC
Inclusion Criteria which may be found at
<http://www.guideline.gov/about/inclusion.aspx> .

NGC, AHRQ, and its contractor ECRI Institute make no warranties
concerning the content or clinical efficacy or effectiveness of the
clinical practice guidelines and related materials represented on this
site. Moreover, the views and opinions of developers or authors of
guidelines represented on this site do not necessarily state or reflect
those of NGC, AHRQ, or its contractor ECRI Institute, and inclusion or
hosting of guidelines in NGC may not be used for advertising or
commercial endorsement purposes.

Readers with questions regarding guideline content are directed to
contact the guideline developer.

Bottom of Form

© 1998-2008 National Guideline Clearinghouse

Date Modified: 11/3/2008