Neonatal apnea: diagnosis by nurse versus computer

Abstract

In an effort to characterize significant neonatal apnea and evaluate the nursing diagnosis of apnea, apnea type and frequency were determined in 27 infants by continuous computer recording of heart rate, respiratory impedance, end-tidal CO2, and either or both transcutaneous oxygen and pulse oximetry. Of the 1,266 recorded apneas, 46% were central, 44% were mixed, and 10% were obstructive. Mixed apnea was associated with a longer mean duration and greater mean decrease in heart rate than central apnea. Apnea duration was positively correlated with both a decrease in heart rate and oxygen saturation (P less than .001), and a lower baseline saturation was associated with a greater decrease in oxygen saturation during apnea (P = .002). Theophylline therapy had no effect on apnea duration or oxygen desaturation but resulted in a decrease in the mean heart rate decrease associated with apnea. Overall, nurses diagnosed 54% of all apneic episodes and were significantly poorer at detecting mixed and obstructive events. Nursing detection of apnea improved with increasing apnea duration and was always associated with a greater decrease in heart rate. Nurses diagnosed significantly fewer mixed apnea following theophylline therapy. Improved monitoring techniques, particularly for mixed and obstructive apnea, are essential to increase apnea detection in the nursery.