EVENT RECORDINGS OF HIGH RISK INFANTS ON APNEA MONITORS

在美国，每年有6000到7000名婴儿死于某种疾病 婴儿猝死综合征(SIDS)。最令人信服的假设 关于小岛屿发展中国家的病理生理学研究表明，死亡的婴儿 心肺控制突然出现异常。努力实现 预防小岛屿发展中国家死亡受阻于无法在 事件发生前的风险以及对 导致终末事件的生理过程。记录在案 经胸阻抗(TTI)/心电图事件记录监护 呼吸和心脏之前、期间和之后的信号 最近出现了改装，并为调查人员提供了 有了一个有用的工具来研究有生命危险事件的婴儿。 这项研究的具体目的是利用最先进的事件 评估FIFE风险增加的婴儿的记录技术 威胁性事件，以便1)提高家庭监控质量，2) 确定监护仪使用的依从性，3)获取生理参数 心肺疾病发作。将建立多中心网络 对大约2000名风险增加的患者进行研究 危及生命的事件：早产儿症状性呼吸暂停 出院，婴儿经历了明显的生命威胁 事件(Alte)没有可识别的原因，以及随后的兄弟姐妹 小岛屿发展中国家的受害者。基线检查将包括红细胞压积、网织红细胞 计数，超声心动图，头颅超声，毛发分析 药物、生长参数和神经发育评估。事件 入院时将开始使用TTI/ECG和脉搏血氧饱和度进行记录 并持续6个月。后续实验室 在6个月和12个月大时的评估将包括红细胞压积， 网织红细胞计数、超声心动图和神经发育评估。 门诊将每周联系患者，每月检查一次 诊所。将分析事件记录以确定1)频率， 呼吸、心脏和减饱和度改变的持续时间和类型， 2)这些改变的生理意义；3)它们之间的关系 对临床结果(异常回声、发育迟缓、生长不良、 和/或死亡)，以及4)遵守监视器的使用。这样做的结果 研究将证明心肺疾病的自然历史 高危婴儿的变化，提供了对 在危及生命的事件中起作用的心肺机制 婴儿有患小岛屿发展中国家的风险，改善家庭监护仪的总体使用情况 在管理高危婴儿方面。

Each year between 6000 and 7000 infants in the U.S. die with a diagnosis of sudden infant death syndrome (SIDS). The most compelling hypothesis regarding the pathophysiology of SIDS suggests that infants who die suddenly have abnormalities in cardiorespiratory control. Efforts to prevent SIDS deaths are hampered by an inability to identify infants at risk prior to the event and the inadequate understanding of the physiologic processes leading to the terminal event. Documented monitoring with event recording of transthoracic impedance (TTI)/ECG signals preceding, during, and following respiratory and cardiac alterations has recently become available and provides the investigator with a useful tool to study infants at risk for life-threatening events. The specific aims of this study are to use state of the art event recording technology to evaluate infants at increased risk for fife threatening events in order to 1) improve quality of home monitoring, 2) determine compliance in monitor use, 3) obtain physiologic parameters of cardiorespiratory episodes. A multicenter network will be established to study approximately 2000 patients at increased risk for life-threatening events: preterm infants with symptomatic apnea at discharge, infants who have experienced an apparent life-threatening event (ALTE) without an identifiable cause, and subsequent siblings of SIDS victims. Baseline studies will include hematocrit, reticulocyte count, echocardiogram, cranial ultrasound, hair analysis for illicit drugs, growth parameters, and neurodevelopmental assessment. Event recording with TTI/ECG and pulse oximetry will be initiated on admission to the study and continued for 6 months. Subsequent laboratory evaluation at 6 and 12 months of age will include hematocrit, reticulocyte count, echocardiogram and neurodevelopmental assessment. Patients will be contacted weekly and examined monthly in the outpatient clinic. Event recording will be analyzed to determine 1) the frequency, duration, and type of respiratory, cardiac and desaturation alterations, 2) physiologic significance of these alterations, 3) their relationship to clinical outcome (abnormal echo, developmental delay, poor growth, and/or death), and 4) compliance with monitor use. The results of this study will demonstrate the natural history of cardiorespiratory alterations in at risk infants, provide insight into the cardiorespiratory mechanisms operative in life-threatening events in infants at risk for SIDS, and improve the overall use of home monitors in managing at risk infants.