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Current guidelines recommending hospital observation for at least 5 to 10 days after the last episode of apnea in otherwise healthy premature infants appears to be supported by clinical investigation. Apnea is the spontaneous cessation of breathing often observed in premature babies. The medical charts of 91 pre-term infants with recurrent apnea were analyzed to determine the maximum interval between the last three apneas experienced before discharge. In babies with no other risk factors for apnea, those who had not had an occurrence for 8 days or more were unlikely to have another., ABSTRACT. Objective. Most neonatologists include an apnea-free period in the criteria for the discharge of preterm infants. However, the length of time one should wait after the cessation of apnea before sending an infant home without a monitor is debated. We undertook this study in an attempt to define a minimal and safe observation period between the time of the last apnea episode and discharge. Methods. We reasoned that in infants with idiopathic apnea of prematurity, the intervals between days on which apnea occurs gradually increase until some point at which clinically significant apnea ceases. Therefore, knowledge about the intervals between days on which apnea occurred just before the last apnea would provide a reasonable estimate of the minimal safe observation interval between the last apnea and discharge. We reviewed the charts of 266 infants born in 1993 and 1994 at [is less than or equal to] 32 weeks&apos; gestational age or weighing [is less than or equal to] 51500 g at birth from two institutions to determine the intervals between the day on which the last apnea occurred and the previous two days on which apnea occurred. One hundred seventy-five infants were excluded because they never experienced apnea, or data about the last apnea was missing, or they were on xanthines during the period encompassing the last 3 apnea days, or they weighed < 1500 g or were < 34 weeks&apos; postmenstrual age at the time of the last apnea. Of the 91 remaining infants, gestational age at birth, birth weight, 1- and 5-minute Apgar scores, and discharge weight were not different between the two institutions. For each infant we determined the longest of the intervals between the 2 days on which apnea occurred previous to the day of the last apnea (MAXINT for maximum interval). The infants were then ordered by MAXINT and, starting at the longest MAXINT, the medical records of each infant were carefully examined for other conditions known to be associated with apnea (eg, recovering from anesthesia, sepsis, chronic lung disease, and so forth). The minimal safe observation period was then defined as the longest MAXINT in which there was at least 1 infant with no other explanation for the apnea other than prematurity. Results. The median duration of the intervals between the 2 days on which apnea occurred previous to the day on which the last apnea occurred were 3.0 and 2.0 days and the median duration of the MAXINT was 4.0 days. On careful examination of the charts, it was determined that each of 13 infants with a MAXINT preceding the day on which the last apnea occurred of greater than 8 days had some other condition that might result in apnea, including residual lung disease, sepsis, surgery, and so forth. In contrast, among the group of infants with a MAXINT of [is less than or equal to]8 days, at least 1 infant at each MAXINT (eg, 1 to 8) had significant apnea with no other explanation other than prematurity. Conclusions. We conclude that otherwise healthy preterm infants continue to have apneas separated by as many as 8 days before the last apnea before discharge. Conversely, infants with longer apnea intervals often have identifiable risk factors other than apnea of prematurity. Pediatrics 1997;100:795-801; apnea of prematurity, premature newborn infant, hospital discharge criteria., ABBREVIATIONS. UVA, University of Virginia; DHMC, Dart-mouth-Hitchcock Medical Center; PMA, postmenstrual age; MAX-INT, maximum interval; ANOVA, analysis of variance; NICU, neo-natal intensive care unit; CPAP, continous positive pressure. A large [...]

This report details the proceedings and conclusions from the 3rd International Congress on Unexplained Deaths in Infants and Children, held November 26–27, 2018 at the Radcliffe Institute at Harvard University. The Congress was motivated by the increasing rejection of the diagnosis Sudden Infant Death Syndrome (SIDS) in the medical examiner community, leading to falsely depressed reported SIDS rates and undermining the validity and reliability of the diagnosis, which remains a leading cause of infant and child mortality. We describe the diagnostic shift away from SIDS and the practical issues contributing to it. The Congress was attended by major figures and opinion leaders in this area from countries significantly engaged in this problem. Four categories (International Classification of Diseases (ICD)-11 categories of MH11, MH12, MH14, PB00-PB0Z) were recommended for classification, and explicit definitions and guidance were provided for death certifiers. SIDS was reframed as unexplained sudden death in infancy or SIDS/MH11 to emphasize that either term signifies the lack of explanation following a rigorous investigation. A distinct category for children over the age of 1 was recommended (MH12). Definitions and exclusions were provided for the alternative categories of accidental asphyxia and undetermined. As recommended, unexplained sudden death in infancy or SIDS on a death certificate will code a unique, trackable entity, accurately reflecting the inability to determine a definitive explanation, while satisfying surveillance needs and reliable identification for research efforts. The conclusions will be submitted to the World Health Organization for inclusion in the upcoming ICD-11. [ABSTRACT FROM AUTHOR]

BACKGROUND: Despite many advances in respiratory care and mechanical ventilation, neonatologists lack an objective tool to aid in decision making for timely extubation. Electrical activity of the diaphragm (EAdi), a measure of neural respiratory drive and inspiratory load, may be a useful predictor of extubation success in preterm neonates. The objective of this work was to investigate whether peak EAdi could distinguish successful versus failed extubation in mechanically ventilated preterm infants. METHODS: We examined peak EAdi as a predictor of extubation outcome in a convenience sample of 21 preterm infants with respiratory distress syndrome requiring mechanical ventilation. Infants were ventilated with a VN500 ventilator using volume guarantee mode and extubated per unit protocol. Peak EAdi was continuously measured with an EAdi catheter in the esophagus to obtain data at 1-min intervals for 24 h before extubation. The primary outcome was extubation success, defined as not requiring re-intubation for at least 72 h. RESULTS: Twenty one premature infants with respiratory distress syndrome included in the study had a mean ± SD) gestational age of 28 ± 2.6 weeks and mean birthweight of 1,208 ± 611 g. The first extubation attempt occurred at a median age of 1 d (interquartile range 1-2 d). One third of the infants failed the first extubation attempt. Infants with failed extubations were significantly smaller (mean ± SD birthweight 788 ± 266 g versus 1,417 ± 632 g) and of lower gestational age (mean ± SD 26 ± 1.9 weeks versus 29 ± 2.6 weeks) compared with those with successful extubation. Mean peak EAdi before extubation did not differ between the 2 groups. CONCLUSIONS: This small study suggests that the pre-extubation peak EAdi does not predict extubation success. (ClinicalTrials.gov registration NCT02144363.) [ABSTRACT FROM AUTHOR]