CARDIORESPIRATORY MONITOR USE IN INFANTS CAN BE PREDICTED BASED ON INITIAL USAGE AND FAMILY FACTORS
Silvestri JM, Lister G, Corwin MJ, Smok-Pearsall SM, Baird TM, Crowell DH, Cantey-Kiser J, Hunt CE, Tinsley L, Palmer PH, Mendenhall RS, Hoppenbrouwers TT, Neuman MR, Weese-Mayer DE, Willinger M; for the Collaborative Home Infant Monitoring Evaluation(CHIME) Study Group. Factors that influence use of a home cardiorespiratory monitor for infants. The Collaborative Home Infant Monitoring Evaluation. Archives of Pediatrics and Adolescent Medicine, 2005;159:18-24.
Preterm infants, brothers and sisters of infants who have died from Sudden Infant Death Syndrome (SIDS), and infants who have had an illness that threatened their lives are often placed on cardiorespiratory monitors at home. However, it is unknown whether parents use the monitors, and consequently, their effectiveness is questionable.
This study, part of the Collaborative Home Infant Monitoring Evaluation (CHIME) carried out in 5 clinical research centers (Chicago, Cleveland, Honolulu, Los Angeles, and Toledo), assessed the use of monitors for at-risk infants over a 5-week period. The aim of the study was to discover the amount of time that the infant was on the monitor as well as what factors in the home environment contributed to the monitor use.
All of the infants (N = 775) were either preterm (less than 34 weeks and less than 1,750 g at birth), a sibling of an infant who died of SIDS, or had experienced a life-threatening episode between 12 hours and 6 months of age. They were born between May 1994 and April 1996 for group 1 (n = 527) or between May 1996 and August 1997 for group 2 (n = 248). Infants were not included in the study if they had significant cardiac or respiratory disease, congenital defects, were on seizure medication or diuretics or steroids, or came from homes where English was not spoken, there was no telephone, or where there was suspected drug use.
Each infant was placed on a newly designed cardiorespiratory monitor. This monitor was complicated to use and not only monitored the heart and respiratory rates, but also gathered pulse oximetry data through a probe on the foot and body position from a probe placed on the diaper. A special hard drive recording device in the monitor saved all data regarding the infant for further retrieval by the researchers. The parents were given lessons on how to use the monitor correctly. In addition, standard demographic data were gathered about the families. Infant data were gathered during the first week of monitor use and for 4 weeks thereafter. Analysis showed that there were few differences between the demographic characteristics of the families of the 2 groups of infants. When the data were analyzed regarding when the monitor was used, during the first week of use it was found that the usage varied related to race and marital status. In weeks 2 through 5, usage was different based on race, martial status, and education. A prediction could be made that the use of the monitor in the first week was relative to the use in the following 4 weeks. In other words, those infants who were on the monitor regularly the first week continued to do so and those whose monitoring lagged in week 1, had lesser and/or decreasing use in the following weeks. These findings were also significant when the 2 groups of infants were compared.
The researchers cautioned that these findings might have been affected by the complex nature of the device and the possibility that parents could not easily use the monitor so they stopped using it. However, these data were similar to other studies that showed that usage of cardiorespiratory monitors is not steady for infants who need them. The researchers discussed that it is imperative for healthcare personnel to completely educate parents and caregivers about the importance of using the cardiorespiratory monitors prescribed for their infants.
HEALTH OF WOMEN PRIOR TO PREGNANCY SHOWN TO AFFECT INCIDENCE OF PRETERM DELIVERY
Haas JS, Fuentes-Afflick E, Stewart AL, Jackson RA, Dean ML, Brawarsky P, Escobar GJ. Prepregnancy health status and the risk of preterm delivery. Archives of Pediatrics and Adolescent Medicine, 2005;159:58-63.
Most healthcare providers who specialize in premature infants have looked at the mother's health during pregnancy as an indicator related to the premature birth. However, little research has been done regarding the mother's health prior to pregnancy.
This research surveyed 1,619 women via telephone about their prepregnancy health status. These women were surveyed 3 times during their pregnancy and once between 2 and 4 months postpartum. They gave information from the Medical Outcome Study Short-Form 36 (MOS SF-36), which gathered information regarding their physical health and role, pain levels, social factors, emotional factors, and mental outlook. In addition, they completed the Center for Epidemiologic Studies-Depression Scale (CES-D) to see whether they exhibited depression and also a standard demographic tool regarding their age, race, marital status, and other socioeconomic factors.
Preterm deliveries were experienced by 129 of the women who then comprised the sample. This indicated that of the complete population surveyed, 8% delivered premature infants. Focus was then placed on those women who had the 25th percentile or lower scores regarding their physical health compared to the rest of the women in the sample. The women were found to be either married or cohabiting and were born in the United States. However, their ethnicity and socioeconomic status were different. More African-American women had preterm infants compared to white, Hispanic, or Asian-American women. About 25% of the sample did not exercise during pregnancy.
The health of the women before they were pregnant was the most obvious indicator of preterm delivery. The women who delivered prematurely were more likely to be underweight, smoked, had histories of hypertension, and poor physical functioning. These factors accounted for 39.8% of the characteristics leading to premature labor.
The researchers noted that there are many other factors that influence preterm delivery, most including risk factors during pregnancy. However, this study appeared to show that prepregnancy health influenced the frequency of preterm delivery in this sample. If healthcare providers can successfully enhance the health of women prior to pregnancy, perhaps some incidences of preterm delivery can be reduced.