86: Apnea of Prematurity: Prolonged Cardiorespiratory Monitoring for Late Preterms Who Presented Respiratory Distress Syndrome

Abstract

Pediatricians are daily confronted with monitoring and safe discharge issues concerning late preterm infants (34 0/7 to 36 6/7 weeks postmenstrual age (PMA)) considering the risk of apnea of prematurity (AOP). Late preterms are 15 times more at risk of AOP when compared with term newborns. Since AOP peak arises beyond the very first days of life, timing and duration of monitoring arouse debate. Current recommandations regarding late preterms hospital discharge do not systematically mandate cardiorespiratory monitoring. The objective of this study was to describe a late preterms population affected by Respiratory Distress Syndrome (RDS) in order to documented AOP prevalence during neonatal intensive care unit (NICU) hospitalization. A descriptive and retrospective study including late preterms with RDS diagnosis, admitted to a tertiary NICU, from January 2009 to December 2011, was conducted. Eighty five late preterms with RDS diagnosis were included and underwent cardiorespiratory monitoring. There was an increase in AOP prevalence with younger PMA; 34.8%, 70.4% and 88.6% for 36, 35 and 34 weeks PMA, respectively (P<0.0001). Caffeine treatment was used in 8.7%, 11.1% and 25,7% of 36, 35 and 34 weeks PMA late preterms, respectively. Late preterms with AOP diagnosis, whether treated or not with caffeine had a longer hospitalization (10.40 vs. 8.18 days, P=0.0019, without caffeine) (13.8 vs. 9.69 days, P=0.047, with caffeine). Patients treated with caffeine presented an extended duration of ventilatory support (5.05 vs. 4.18 days, P=0.027). The unexpected discovery of AOP high prevalence and its association with caffeine treatment in monitored late preterms admitted for RDS highlights that current recommendations about safe discharge in late preterms are not optimal when addressing this specific population. RDS occurrence in near term infants reflects their immaturity and consequently, their susceptibility to AOP. Therefore, late preterms should be considered for an extended period of monitoring after RDS resolution. Further studies are necessary to determine if recommandations should be made requiring a normal respirogram record or a seven-day period without apnea before safe discharge in late preterms.