Apnea monitors signal when the breathing rate falls dangerously low. These monitors may be used for premature infants; those with life-threatening medical emergencies; and those with neurologic, respiratory, or cardiac problems. It is also used in a family history of sudden infant death syndrome or in cases of acute drug withdrawal.

Two types of monitors are used most commonly. The thoracic impedance monitor uses chest electrodes to detect conduction changes caused by respirations. Some models have alarm systems and memories that record cardiorespiratory patterns. The apnea mattress, or underpad monitor, relies on a transducer connected to a pressure-sensitive pad, which detects pressure changes resulting from altered chest movements. The nurse should always assess for the time length of the apnea, oxygen saturation level, and heart rate.

Many facilities will perform a car seat challenge assessment on the baby with apnea before discharge to determine if the baby develops apnea (>20 seconds), bradycardia (<80 beats/minute), or decreased oxygen saturations when sitting in the car seat for 90 to 120 minutes. If the baby passes the car seat challenge, the baby will not necessarily need home apnea monitoring.

Home delivery

Monitoring begins in the hospital (or birthing center) and continues at home, so parents will need to learn how to operate the monitor and what actions to take when the alarm sounds. (See Using a home apnea monitor.)

What you need

Monitor unit electrodes leadwires electrode belt electrode gel if needed pressure transducer pad, if using apnea mattress stable surface for monitor placement. Prepackaged and pretreated disposable electrodes are available.

Getting ready

Plug the monitor's power cord into a grounded wall outlet. Attach the leadwires to the electrodes and attach the electrodes to the belt. If appropriate, apply conduction gel to the electrodes. (Or apply gel to the neonate's chest, place the electrodes atop the gel, and attach the electrodes to the leadwires. Then secure the belt.)

How you do it

• Explain the procedure to the parents and perform hand hygiene.

Thoracic impedance monitoring

• To hold the electrodes securely in position, wrap the belt snugly around the neonate's chest at the point of greatest movement—optimally at the right and left midaxillary line about 4/5'' (2 cm) below the axilla. Be sure to position the leadwires according to the manufacturer's instructions.
• Follow the color code to connect the leadwires to the patient cable. Then connect the cable to the proper jack at the rear of the monitoring unit.

You're so sensitive

• Turn the sensitivity controls to maximum to facilitate tuning when adjusting the system.
• Set the alarms according to recommendations so that an apneic period lasting for a specified time activates the signal.
• Turn on the monitor. If the monitor has two alarms—one to signal apnea, one to signal bradycardia—both will sound until you adjust the monitor and reset the alarms according to the manufacturer's instructions.
• Adjust the sensitivity controls until the indicator lights blink with each breath and heartbeat.

Apnea mattress or underpad monitor

• If you use an apnea mattress or underpad monitor, assemble the monitor and pressure transducer pad according to the manufacturer's directions.
• Plug the monitor into a grounded wall outlet and plug the cable of the transducer pad into the monitor.
• Touch the pad to make sure it works. Watch for the monitor's respiration light to blink.

Practice pointers

• Avoid applying lotions, oils, or powders to the neonate's chest, where they could cause the electrode belt to slip.
• Periodically, check the alarm by disconnecting the sensor plug. Then listen for the alarm to sound after the preset time delay. (See Documenting apnea monitor use.)