Apnea monitoring in pediatrics involves the continuous observation of a child’s breathing and heart rate to detect episodes of apnea—defined as a pause in breathing lasting more than 20 seconds, or shorter if accompanied by bradycardia or oxygen desaturation. It is especially critical in preterm infants, postoperative neonates, and those with neurological or respiratory conditions.
An impedance-type device that monitors both the respiratory and heart rates of an infant and sounds an alarm alerting caregiver of a possible need to perform CPR in the event of either apnea or a marked increase or decrease in heart rate.
Indications for Apnea Monitoring
| Clinical Scenario | Rationale |
|---|---|
| Premature infants (<37 weeks) | Immature respiratory control increases risk of apnea of prematurity |
| Postoperative monitoring | Anesthesia and opioids can suppress respiratory drive |
| History of BRUE (Brief Resolved Unexplained Event) | To detect recurrence and guide diagnosis |
| Neurological disorders | Conditions like seizures or brain injury may impair respiratory regulation |
| Home monitoring for high-risk infants | E.g., infants with chronic lung disease or post-extubation care |
Types of Pediatric Apnea Monitors
| Type | Description |
|---|---|
| Hospital-based monitors | Use ECG leads and pulse oximetry for continuous monitoring in NICU/PICU settings |
| Home apnea monitors | Track breathing and heart rate; may include mattress sensors or wearable belts |
| Smart monitors (consumer-grade) | Not FDA-approved for diagnosis; used for reassurance but not clinical decisions |
Preparation of Child and Parents
- Review the child’s chart to determine the reason for apnea monitoring.
- Examine the skin to ensure that there is no powder, perspiration.
- Explain the parents the reason for keeping the infant on monitor.
Procedure
- Perform hand hygiene.
- Collect the equipment.
- Inspect the electrodes and leads for proper functioning.
- Place the monitor away from the walls and on a firm surface.
- Place the infant in a supine position.
- Turn the apnea monitor (preset of apnea\alarm lapse will be done by vendor or respiratory therapist)
- Place the white lead to the patient’s right chest above the nipple and black lead on left side. The inserts of the lead wire should point from the hands.
- Connect the lead wire into apnea monitor and then it on as per manufactures instruction.
- Remove all the equipment from the contact with the child skin for at least 10-15min/day. During this time meticulous skin care should be given.
Nursing Responsibilities
- Ensure proper sensor placement and skin integrity.
- Respond promptly to alarms—assess the infant before silencing.
- Document apnea episodes, duration, associated symptoms, and interventions.
- Educate caregivers on monitor use, alarm response, and CPR if home monitoring is prescribed.
Emergency Response Protocol
If the alarm sounds:
- Check the infant immediately—look for chest movement and color.
- Stimulate gently—rub the back or tap the feet.
- If no response, initiate CPR and call emergency services.
- Document the event and notify the healthcare provider.
Special Considerations
- False alarms are common—verify with clinical assessment.
- Do not rely solely on monitors—visual observation remains essential.
- Discontinue monitoring based on clinical stability and provider guidance (typically after 2–3 months at home).
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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