Clinically significant cardiopulmonary events and the effect of definition standardization on apnea of prematurity management

Objective: To define the impact of care standardization on caffeine and cardiorespiratory monitoring at neonatal intensive care unit (NICU) discharge. Study Design: Electronic records were abstracted for infants aged 24–36 weeks gestation with birth weights appropriate for gestational age. Infants who died, transferred prior to discharge, had major pulmonary anomalies, required a home monitor for mechanical ventilation or had a family history of sudden infant death syndrome were excluded. Data and records were used to indicate when the new definition of clinically significant cardiopulmonary events (CSCPEs) and concurrent education was implemented. Preimplementation and postimplementation cohorts were compared. Results: Incidence fell from 74% diagnosed with apnea of prematurity at baseline to 49% diagnosed with CSCPE postimplementation ( P< 0.001). Infants discharged on caffeine reduced from 17% to 5% ( P< 0.001), and home monitor use also fell from 54% to 16% ( P< 0.001). Conclusion: Standardizing definitions and treatments reduced the use of caffeine and cardiorespiratory monitors upon NICU dismissal.