Apnoea Monitoring Service
Normal breathing
The breathing pattern of newborn babies and infants less than 12 months old is different to that of older children and adults. Whereas the brain of an older child or adult sends signals that result in a slow and regular breathing pattern, babies and infants have a faster breathing rate that is less regular. In particular, babies can have pauses in regular breathing as well as periods when they breathe much faster, as if they are short of breath.
Apnoea
A prolonged pause in breathing is called an ‘apnoea’. As mentioned above, short pauses in a baby or infant’s breathing lasting a few seconds are normal. Rarely, a baby might have a pause as long as five seconds. A breathing pause of 20 seconds or more (a significant apnoea) is always abnormal and suggests a problem with breathing.
Significant apnoea can happen for a number of reasons:
- Acute severe illness e.g. infection
- In association with seizures
- Choking e.g during feeding or in babies with gastro-oesophageal reflux, if milk regurgitates at times other than at feeds and ‘goes down the wrong way’
- In an ex-premature baby
- Sudden infant death syndrome (SIDS)
Monitoring for apnoea
In hospitals, the adequacy of a person’s breathing is assessed with an oximeter, a device which continuously measures the oxygen level in the blood via a probe attached to a finger, toe or ear lobe. At home, this type of breathing monitoring is impractical as the monitor tends to alarm frequently in response to patient movement.
Instead, in babies and infants at risk of apnoea, a monitor is used that detects the regularity of breathing (an apnoea monitor). Apnoea monitors have been found to be a safe and effective way of assessing the regularity of a baby or infant’s breathing. One type of monitor consists of a pad that the baby lies on and which detects breathing movements. The monitors we prefer and recommend use an air-filled capsule fixed to the baby’s lower ribcage with sticky tape. Breathing efforts cause a change in the capsule shape and thus the pressure within it; this change in pressure is transmitted to a battery-operated breathing monitor through hollow tubing. If no breathing effort is detected for 20 seconds, the monitor alarms.
In most infants, it is appropriate to continue monitoring until the age of six months.
Infant resuscitation
There is little benefit in being alerted to an apnoea if the person alerted is unable to deal with the situation whilst waiting for emergency help. Providing first aid to a person with apnoea is called resuscitation.
Resuscitating a baby or young infant, although anxiety provoking, is actually quite simple. Like in other age groups, the general principle is:
- Airway – clear the nose and throat and then position the head and neck to keep the breathing passages open
- Breathing – stimulate and support breathing by placing your mouth over the nose and mouth of the baby/infant and by blowing out regularly to fill the lungs
- Circulation – it is rare to have to support a baby or infant’s circulation by using cardiac massage (also known as compressions). With your thumbs (in a baby) or using your hands linked together (in an infant), regularly compress the middle part of the breastbone; this squeezes the heart and causes blood flow around the lungs and body.
Medical assessment
Prior to our service providing a monitor and resuscitation instruction, we feel that it is important to ensure that it is appropriate for the baby or infant to be monitored. This is because there may be an underlying problem in the child that needs investigations and/or other treatment. This is because there may be an underlying problem in the child that needs investigations and/or other treatment. For this reason we prefer that patients wishing to hire an apnoea monitor obtain a referral from their paediatrician or GP (this is not necessary to undergo resuscitation training alone).
Apnoea monitor hire
Our service has apnoea monitors available for hire that are suitable for checking breathing regularity in children aged less than 12 months. We only rent out the monitors after providing one-to-one resuscitation instruction to one, or preferably both, parent(s).
Parents are provided with a monitor and batteries, a breathing lead, and tape for sticking the capsule to the chest wall. Spare batteries, a lead and roll of tape are also provided. Further leads and tape can be provided subsequently if required.
Resuscitation instruction
Pre-session reading material will be provided to ensure that parents can quickly become proficient in providing resuscitation. After learning how to attach and use the apnoea monitor, parents will receive one to one resuscitation instruction. Our resuscitation nurse instructs parents how to help a baby with apnoea. Using a life-sized manikin, parents will have the opportunity to practice the ABC techniques listed above.
Costs
The resuscitation training by our nurse will cost $125 and is not claimable through Medicare.
High quality breathing monitors are an expensive item of equipment and so we ask for a $500 deposit at the time of rental; this is fully refundable upon receipt of the monitor in full working condition at the end of the rental period (a stamp addressed padded envelope is provided).
These charges for the resuscitation training and monitor deposit, are payable at the time of the initial consultation and receipt of the monitor.
Monitor rental is $140 per calendar month; this is charged by automatic deduction from your credit card from the date you attend your appoint and monthly thereafter. As soon as the monitor is returned we will arrange the refund of the deposit and no further deductions will be made.
Resuscitation training without monitor hire
We acknowledge that some parents and grandparents may request resuscitation training without the hire of the monitor. Our resuscitation nurse is happy to provide this; the cost of this training will also be $125 per session. Sessions usually take place on Tuesday mornings and last for around an hour.