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NeoReviews Vol.6 No.5 2005 e207
© 2005 American Academy of Pediatrics

Historical Perspectives

Monitoring the Newborn for Apnea

The first 300 words of the full text of this article appear below.


   Cardiopulmonary Monitoring
 
Among the factors considered "standard operating procedure" in neonatal intensive care units today, the presence of monitors is key. Bedside monitoring almost defines neonatal intensive care. It is difficult to recall that it is less than 40 years ago that cardiopulmonary monitors were introduced into routine intensive care. Prior to their introduction, the bedside nurse was responsible for taking vital signs at intervals dictated by the severity of illness of the baby.

This month’s contribution comes from Dr Joe Daily, who describes the early attempts to incorporate electronic monitoring into the care of premature (preterm) infants who had apnea. The technique involved the use of transthoracic impedance, which can detect both respiration and heart rate activity. At the time it was introduced, the application of electrodes to the chest seemed rather "invasive," and subsequent attempts were made to use other types of monitoring devices that did not require attachment to the baby’s chest. As indicated by Dr Daily, our major concern at the time was the detection of apnea, and air mattresses were used in some nurseries for a while because they could detect breathing movements. However, other types of motion artifact (particularly seizure activity) could trigger the sensors for breathing and produce "false-negatives."

Not long after the apnea monitor was introduced, it became evident that monitoring of heart rate could provide additional useful information. Consequently, cardiopulmonary monitoring became the norm, to be followed by blood pressure monitoring (see NeoReviews, May 2003), transcutaneous blood gas monitoring (see NeoReviews, September 2003), and oxygen saturation monitoring.

In providing this recollection, Dr Daily was quick to point out to me that many people, over a long period of time, were involved in the evolution of the technology that led to the first apnea monitors used at Stanford.

Alistair G.S. Philip, MD, FRCPE, Coeditor, NeoReviews

 

Now 35 years ago, . . . [Full Text of this Article]

William J. R. Daily, MD

Neonatology Associates, Ltd.
Phoenix, Ariz.
Chairman
District VIII Perinatal Section
American Academy of Pediatrics


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