Anemia of Prematurity - Portal Neonatal

o Despite the number of premature infants receiving home monitoring, this therapy has not
been embraced universally and remains controversial. Advocates of home monitoring
believe that monitoring can alert caretakers to potentially serious episodes of apnea
and/or bradycardia before they cause harm, helping parents to cope with the anxiety of
caring for an infant born prematurely.
• Opponents of monitoring cite the lack of evidence to indicate that these devices alter the
outcome for these patients in any definable way. To the author's knowledge, no prospective
study findings demonstrate that monitoring prevents SIDS. Furthermore, many physicians
believe that the decision to use home monitoring creates a significant emotional burden for
parents.
• Non-SIDS monitoring issues
o Since the introduction of NICUs, preterm neonates have received an extraordinarily high
level of medical support to compensate for their varying degrees of organ immaturity at
birth.
o Unfortunately, the effectiveness of current NICU technology cannot begin to approach the
combined effectiveness of the placental circulation and maternal metabolism. As a result,
some premature babies survive with varying degrees of injury to certain organ systems.
o Bronchopulmonary dysplasia (BPD), cardiac disease, periventricular leukomalacia and
other neurologic problems, and feeding difficulties are among the many problems that
may require home monitoring for ongoing medical care. In these cases, monitoring
appears valuable to alert caretakers to physiologic changes (eg, bradycardia, tachycardia,
hypoxemia, seizures) that may require intervention.
o Without home monitoring, many infants would be unnecessarily confined to the hospital,
with far greater emotional and financial costs to the child and family than if they were at
home. In such instances, home monitoring may be an effective and safe approach to
medical care.
o Home monitoring also may be an effective diagnostic tool for children whose events are
so sporadic that they cannot be detected easily in the hospital.
� Newly developed, documented, monitoring devices can be used to detect and quantify
these infrequent episodes of apnea or ALTE, while creating a more typical situation
for the child.
� The detection of frequent events may indicate the need for additional evaluation for a
specific cause. Studies such as EEG, ECG, CNS imaging, and metabolic testing may
be valuable in such instances.
o Whether the reduction of apnea with the use of monitoring devices and/or pharmacologic
agents (eg, methylxanthines) improves neurodevelopmental outcomes in infants born
prematurely is not known. Because of the complex nature of the infant's problems, the
contribution of apnea to any developmental disability is difficult to estimate. Frequent
apnea, especially when accompanied by bradycardia and oxygen desaturation, may
adversely affect neurodevelopmental outcomes and should be resolved, if possible.
o Neonatologists are aware of the parents' substantial anxiety when they take their lowbirth-weight
infant home. With recent changes in inpatient care, many premature babies
now leave the hospital with discharge weights of 1800-2000 g. In such circumstances,
home monitoring may help the infant make the transition to the home setting. Carefully
train all caretakers who have a child who is being monitored at home in how to use the
monitor and how to perform CPR. Clearly inform parents that monitoring might not prevent
SIDS.