Apnea Episodes Updated: 9/12/2010& 8/12/2013

Apnea Episodes Updated: 9/12/2010& 8/12/2013 See also Life Threatening chart

None Occur during KC Cattaneo et al., 1998 PT, RCT, no apnea episodes during KC Chen et al., 2000 PT, descrip. No apnea, no desats during BF in KC, but 2 apneas during bottle feeding in KC. NO APNEA Clifford & Barnsteiner 2001 PT, descriptive, no apneas during KC. NO APNEA Hall & Kirsten 2008 PT reviews a study in which apnea was absent during KC Ludington-Hoe et al., 2004 PT, RCT, no apneas during KC as compared to incubator time. Mooncey et al., 1997 PT, descriptive, healthy, stable, spontaneously breathing NO apnea during 20 minutes of KC, NO APNEA in KC Parmar et al., 2009 PT, clinical report. No apnea episodes during 4 hour sessions of KC in infants <32 weeks pma NO APNEA Tornhage et al., 1999 PT, one group, quasiexp. VLBW pretest-test- posttest. One episode of apnea after study was over and during blood draw only. No apneas in 17 KC sessions > 60 minutes each with 3 day old unstable babes on CPAP and ventilators. UNSTABLE babies.NO APNEA Wahlberg et al., 1992 PT. Descriptive. No problems with apnea during KC. NO APNEA

No Change in # of Apneas (No increase, no decrease, no difference in #/% of apneas) Acolet et al., 1989 PT, VLBW at 35 days. Stable, # of apnea. NO infant had any apnea nor bradycardia during KC. NO diff between those who had KC first and those who had KC second (changing from incubator). NO APNEA Bohnhorst et al., 2004 PT, Quasiexp. pretest-test-posttest of 22 32wkers. “Frequency Of isolated apneas >10 seconds was unchanged” (pg. 500). Apnea with desats increased. NO DIFF. NO INCREASE in APNEA during KC, so KC is safe

Bosque et al., 1995 PT, one group Pretest (incubator)=test (KC)- posttest (incubator) design. No difference in apnea between KC and incubator periods. NO DIFF Canadian Paed.Society 2012 PT, Position statement reflecting that KC does not increase apnea, therefore KC is safe. De Leeuw et al., 1991 PT, pretest-test-posttest one group. 8VLBW unstable infants. 1.8 apnea attacks (>10 sec) in pretest, 1.4 in KC, 1.4 in posttest; % time in apnea was 0.9 (pretest), 0.6 (KC), 0.6 (posttest), but No Sig Diffs. NO DIFF between periods Filho et al., 2008 PT, clin eval of 8 KC units vs 8 no KC units. No difference in % of infants having apnea during intermediate care between units. Ghavane et al., 2012 PT,RCT, micropreemie, RCT, showed that apnea was same in 24/7 KMC grp as in NICU incubator care grp. Heimann et al. 2010 PT, VLBW, comparative effectiveness descripitive study, micropreemie (24-32 wks). 120 mins of KC vs 120 mins in supine and prone. In KC NO INCREASE in apnea vs supine/prone position in incubator Kadam et al., 2005 PT, RCT. No difference in # of apnea between KC and conventional care (radiant warmer) stable preterms. KMC=6 apneas; controls = 8 episodes NO DIFF in apnea between groups. No periods,just KC vs. radiant warmer. Ludington-Hoe et al., 1991 PT. Quasiexp, pretest-test-posttest No differences in apnea between periods NO DIFF Messmer et al., 1997 PT, Quasiexp. pretest-test-posttest one group. Infants experienced few episodes of apnea and bradycardia in each period. NO DIFF Some Apneas occurred Carbasse et al., 2013 PT, VLBW, Ventilated, apneas and brady in19/141 KC episodes, but none required termination of KC

Increase in Number of Apneas Bohnhorst et al., 2001 PT, pretest-test-posttest of 22 preterms. proportion of regular breathing decreased during KC. Changes may be due to heat stress. APNEA INCREASED Bohnhorst et al., 2004 PT, same sort of study and APNEA INCREASED Whitelaw et al., 1988 PT, RCT. 6 babies in each group stopped longitudinal study due to apnea/nec/sepsis that occurred during hospitalization. No other apnea data. Wieland et al., 1995 PT, Descript. Four of 167 KC sessions had to be stopped for increasing apnea/bradycardia. NO PROBS WITH APNEA EXCEPT ONCE Decrease in Number of Apneas during KC De Leeuw, 1987 PT, descriptive case study of very small preterm having intractable apneic attacks that diminished during KC due to improved breathing pattern. They then moved to routine use of KC to improve vital functions at Univ. Hospital of Univ. of Amsterdam. APNEA DECREASE Eichel 2001 PT, Clinical report of Vented babies had fewer Apnea episodes in KC. DECREASE Hadeed et al. 1995 PT, RCT 75% reduction in apnea of prematurity. DECREASE – Published abstract Hadeed et al., 2006? PT, RCT, 79-83% reduction inAOP. DECREASE Hardy, 2011 PT, review of L-H’s chapter in Dev Care text and reiterates that apnea decreases with KC Heimann et al., 2010 PT, apnea decreases with KC and does so same as placing infant in prone position. Lehtonen & Martin, 2004 PT, Review. Apneas occur during indeterminate sleep and during arousals from sleep, but KC improves sleep so may impact apnea. Ludington-Hoe, et al. 1994 PT.Descriptive pilot Sig fewer apnea (& PB) episodes, no obstructive Apnea DECREASE Ludington-Hoe et al. 1994 PT. pilot RCT. Decreased frequency of total apnea episodes (Day1 +Day5); significant difference between groups on length of apnea (shorter ones in KC)(pg.22). DECREASE Ludington-Hoe et al., 1998 PT. Case study Decrease in duration of central apnea (p713) during vent KC with one subject. DECREASE Ludington-Hoe et al., 2001 PT, Quasi exp. one group pretest-test-posttest. Apnea decreased during KC period. DECREASE Maastrup & Greisen, 2010 PT, quasi exp pretest-test-posttest reported that mean number of apneas requiring stimulation were 12 (pretest), 5(test) and 6(Posttest) Meier, 2003 PT, Review. Encourages KC to reduce apnea even in smallest ventilated baby as they have seen in their practice.DECREASE Rao et al., 2008 PT, RCT, significantly reduced incidence of apnea during KMC which was 13.5 hrs/day (pg.19). DECREASE Spatz, 2004 PT, Reviews KC beneficial effects on apnea.

MAY BE TREATMENT FOR APNEA Zhao, et al., 2011 PT, clinical review of pathophysiology and treatments for apnea and says that KM has been found to reduce apnea (Ludington-Hoe et al., 2004) but Bohnhorst et al 2004 found an increase, and Heinemann found improvement in apnea with KC was same as that with prone positioning. KC as a treatment but needs more testing.

READMISSION FOR APNEA AFTER KC Torres et al., 2006 PT, descriptive of 66 LBW in KMC.Anemia and GER were main morbidity problems before term age but one child was readmitted for apnea after discharge. Is this a KC outcome? I don’t think so.

Palencia et al., 2009 PT, 5.3% of 390 infants were readmitted before 40 wks pma for apnea and anemia after discharge from KMC in Cali, Colombia.Not doing KMC when having apneas

Apneas as SIDS events Branger et al. 2007 FT. 7 deaths during KC in France. Case studies.See Nakamura too. Dageville et al., 2008 FT, 2 ALTEs occurred with apnea during BirthKC Espagne et al., 2004 FT, ALTEs with birth KC in France Hays et al., 2006 FT, 11 ALTES and apnea during Birth KC in France Nakamura 2007 FT, infants who needed resuscitation during Birth KC, see Branger above too Issues with Apnea: Kluthe et al., 2004 PT, extra systoles from mother. Says watch SaO2 Instead to determine if apnea is occurring.

Mallet et al., 2007 PT, Descriptive. NICU staff were WORRIED about the safety of kc in relation to Apnea /Bradycardia. . Nyqvist, 2005 PT, clinical report, No restrictions for KMC unless severe apnea or brady is in infant.CONTRAINDIC Nyqvist, 2009 PT, FT, apnea during transfer into KMC or during routine caregiving is obstacle to KC.CONTRAINDICATION

SEE Life Threatening Event file too for other reports of apnea needing resuscitation in fullterm and preterm infants.

APNEA in GENERAL -Occurs more frequently in Active Sleep than Quiet Sleep and more often when \infant was warmer than when cooler, and apnea is less frequent and shorter in cool condition. The greater the infant’s body heat loss, the less frequent and shorter the apnea episodes were. Apnea is more closely related to body heat loss than body temperature. Apnea episodes depend on the metabolic drive (which is proportional to energy expenditure). No relationship between apnea and skin/rectal temperatures was found. Tourneux P, Cardot V, Museux N, Chardon K, Leke, A., Telliez F, Libert JP, & Bach V. (2008) Influence of thermal drive on central sleep apnea in the preterm neonate. Sleep, 31(4), 549-556