Undetected Episodes of Prolonged Apnea and Severe Bradycardia in Preterm Infants

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Abstract
Twenty-four-hour tape recordings of ECG and breathing movement were made on 14 preterm infants with prolonged apneic episodes. Despite apnea monitoring systems, 136/203 (67%) apneic episodes ≥20 seconds in duration, including 19 episodes ≥50 seconds in duration, were not recorded by nursing staff. Of 120 apneic episodes ≥30 seconds, 100 (89%) were accompanied by bradycardia ≤100 beats per minute. Episodes of more marked bradycardia (≤80 beats per minute and up to seven minutes in duration) occurred without cessation of breathing movement in 10/14 infants studied. Treatment with theophylline or aminophylline was associated with a reduction in the number of episodes of apnea ≥20 seconds accompanied by bradycardia ≤80 beats per minute (P < .001). Many prolonged episodes of apnea and bradycardia are going unnoticed in neonatal intensive care units. Further studies are required to investigate and overcome the causes of these failures.