Taking Your Preemie Home With an Apnea Monitor

The Home Cardiorespiratory Monitor: Information & Tips

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Apnea is a common problem in preemies. When a baby has an episode of apnea, there is a pause in his breathing that lasts at least 20 seconds. During the pause, the baby’s heart rate may go down (bradycardia), and the oxygen level may drop, too. In the neonatal intensive care unit (NICU), premature babies are hooked up to monitors with alarms that go off when the baby has apnea or bradycardia. As the babies grow and mature, the apnea improves until it eventually goes away.

But sometimes a baby is ready to go home before the apnea is completely gone. If your baby is otherwise healthy and ready for discharge but continues to have occasional episodes, he may still be able to leave the hospital. You’ll just have to take him home with an apnea monitor.

The Home Apnea Monitor

The home apnea monitor is called a cardiorespiratory monitor. An apnea monitor keeps track of your baby’s breathing and heart rate. It has a belt that goes around your child’s chest to measure how often the baby is breathing, and a set of electrodes or leads that attach to the baby’s chest to detect and monitor the heartbeat. Just like when you were in the NICU, an alarm will sound if your child has a long pause in breathing or his heart rate goes down too low. 

The Pros & Cons of the Home Apnea Monitor

After getting used to all the monitors in the NICU or special care nursery, it can be reassuring to have one at home.

The monitor might give you a boost of confidence if you're feeling anxious or worried about leaving the security of the around-the-clock care in the hospital.

On the other hand, bringing home a monitor can be a source of stress and a constant reminder that your baby was born early. It may make you feel like you can’t leave the hospital and the preemie experience behind you.

Other negatives that come with the home apnea monitor are: 

  • You have to learn how to use the monitor and take extra safety precautions. 
  • The false alarms can be scary and annoying.
  • Going out to run errands or visit friends and family is more of a hassle. The monitor does come with a battery pack so you can leave the house, but it's something extra you have to carry around along with all the other baby equipment you need. 
  • It may be more difficult to find someone who has the knowledge and the confidence to care for your child. You have to find a babysitter or family member who can deal with alarms and handle an emergency if necessary.  
  • Going home with a monitor may make you feel like your child is not healthy. You may be scared to leave your child and become overprotective.

Taking Time Off of the Monitor

Some babies need to stay on the monitor as much as possible, except during bath time and lead changes. Other infants can spend time off of the monitor when they're awake and someone is watching them carefully. You can speak to your child’s doctor about how you should use your monitor at home. 

Bath time: You don’t have to bathe your preemie every day. But, when you do, you have to either remove the leads or disconnect them from the monitor.

Electricity and water don’t mix.

Playtime: If your baby’s doctor says it’s OK, you can take your baby off the monitor when she’s awake and ready to play. Not only is it a welcome change to interact with your baby and play with her without the monitor, but it’s also nice to have a break from carrying the monitor around and dealing with the wires.

Changing the Leads

Some monitors use electrodes that stick to the baby’s skin, and other monitors use leads without adhesives that are held on by the chest belt. Sticky electrodes tend to stay in place better to prevent false alarms, but non-stick leads can work well for a baby with sensitive skin.

Here are some tips for working with leads that stick to the baby.

When to change the electrodes: You don’t have to change the leads if they are secure in the right place and your baby’s skin is intact. However, if you are removing the leads before you give a bath, they are no longer sticking, or your baby’s skin is red and irritated at the site, you’ll want to put on a new set of leads.

Removing leads: Be careful when it's time to take the electrodes off of your baby. If they are stuck on well, don’t pull them off. You can gently remove them by soaking them with water (when they are not attached to the monitor) or by using a safe medical adhesive remover.

Checking the skin: Each time you change the leads, check your baby’s skin. If the skin looks red, bumpy, or blistered, don’t put another electrode back over that exact spot. Instead, place it on the healthy skin next to that area and allow the irritated spot to heal. Just be sure that the new placement is still good enough to get a reading on the monitor and prevent false alarms. If your baby has sensitive skin that becomes very irritated from the leads, talk to the pediatrician.

Reusing leads: If you remove the leads for a bath, you can reuse them if they are still sticky. However, if they lose their stickiness and become loose, they’re more likely to trigger false alarms.

Sticky problems: You should not use oils, lotions, or creams on your baby’s chest unless the doctor tells you to do so. It is much more difficult to get the leads to stick well on slippery skin.

Dealing With Alarms

Let’s face it; it can be scary when that alarm goes off. Especially the first few times or in the middle of the night. And, it will go off. Just do your best to stay calm and get to your baby as quickly as possible.

False alarms: One of the downsides of taking your baby home with a monitor is dealing with false alarms. False alarms may happen when:

If you check your baby, her color looks good, and you can see or feel that she is breathing, it’s probably a false alarm. But remember, even if you’re getting a lot of false alarms, always check the baby. You never know when one of those alarms might be real. 

Real alarms: Some real alarms will look like false alarms because, by the time you rush to the baby, she’ll have already started breathing again on her own. Just the sound of the alarm is all some babies need to end an episode. But if you get to your baby and she is having an episode, try to remain calm and stimulate her to breathe. You can gently rub her feet or her back, or pick her up and rub her back. That should be enough to get her to take a breath. If she’s pink and breathing, then everything is OK. Keep a log of any episodes that the baby has so you can show the doctor.

Emergencies: If you respond to an alarm and find your baby pale or turning blue (especially around her mouth) and she’s not breathing or not responding, start CPR and call 911 or your local emergency number.

Preparing for Emergencies

Even though you hope you will never have to use your emergency plan, you should still have one. Take the time to prepare for an emergency, talk about it, and include all the people who care for your child in the plan. 

  • Keep emergency phone numbers available. Place them near your home phone and program them into your cell phone. 
  • Take an infant CPR course, and have anyone who watches your child learn CPR, too. You can keep the CPR guide in an easily accessible place and hang the basic instructions in the house in case you need to refer to them. You’ll probably never have to use it, but it’s important to know how just in case. 
  • Notify the power company, telephone company, and emergency services in your area that you have a child with health concerns. In case you lose power, or there is a disruption in a necessary service, these companies keep a list of customers who need to have services restored first.
  • When you’re home, keep the monitor plugged in as much as possible so that it’s not running on battery power. If you have a separate battery pack, keep it charged and ready to go in case you need it right away. 
  • Keep a spare chest belt, and few extra sets of leads on hand, too.  

Monitor Safety

Home cardiorespiratory monitors are very safe. But there are few guidelines that you should follow to prevent unnecessary dangers. 

  • Use caution when dealing with the monitor’s wires. When you dress your baby, don’t put the electrode wires through the top (neck) of your child’s clothing. Wires around your child's neck can become a choking hazard. The safest way to dress a child on the monitor is to gently pull the wires down through the bottom of his onesie or shirt. 
  • Always disconnect the baby from the monitor before a bath or any other water activity to prevent an electric shock. 
  • Don’t leave your child alone with pets or other children. Young children and pets may find the monitor and wires interesting. Be sure to pay attention and keep the monitor and your child out of the way of danger.
  • Don’t vacuum, listen to loud music, wear headphones, or take a shower when you’re alone with the baby. Wait until you have someone with you to keep an eye on the baby before you do anything that might interfere with your ability to hear the monitor. 
  • When traveling with your child in a car, keep the baby on the monitor and position her correctly in the car seat so she can breathe freely. Since the monitor is heavy, be sure to secure it in a safe place. It can be dangerous if it gets thrown from an unsafe position during a sudden stop or a car accident. 

How Long Your Baby Will Need a Home Apnea Monitor

There isn’t a set amount of time that a child uses a home monitor. How long your child stays on the monitor depends on her needs. Your child’s doctor will let you know when it’s safe to wean off the monitor or stop using it altogether. It may be after a few months without any episodes, when your child reaches six months old, or when the doctor believes that your child no longer needs it. It’s different for every child because every child is unique. 

A Word From Verywell

After a long road in the NICU or special care nursery, it so exciting to finally take your baby home and leave the hospital behind. Going home from the NICU with an apnea monitor may be overwhelming, but it won’t take long to get the hang of it. Sure, it’s an extra load to lug around and deal with, but once you get used to it, it’s not that bad. It may even help you sleep better at night knowing that you don’t have to get up to continually check on the baby. Then, before you know it, your baby will grow and mature, and the doctor will say that you don’t need it anymore. 

When you finally get the news that it’s time to get rid of the monitor, you may be delighted. But it’s a big adjustment. Many parents are a little nervous about it, too. Some families continue to use the monitor even after the doctor says it’s OK to stop. Instead of giving it up all at once, you may want to wean yourself from it. You can use the monitor a little less each day until you begin to feel more and more comfortable about moving on without it. 

Sources:

Bull MJ, Engle WA. Safe transportation of preterm and low birth weight infants at hospital discharge. Pediatrics. 2009 May 1;123(5):1424-9.

Committee on Fetus and Newborn. Apnea, sudden infant death syndrome, and home monitoring. Pediatrics. 2003; 111 (4): 914-17. Reaffirmed May 2007.

Eichenwald EC. Apnea of prematurity. Pediatrics. 2016 Jan 1;137(1):e20153757.

Jefferies AL. Going home: facilitating discharge of the preterm infant. Paediatrics & child health. 2014 Jan 1;19(1):31-6.

Zenk KE. Neonatology: management, procedures, on-call problems, diseases, and drugs. Seventh Edition. Gomella TL, Cunningham MD, Eyal FG, editors. McGraw-Hill Education Medical; 2013.

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