Polysomnography use in complex term and preterm infants to facilitate evaluation and management in the neonatal intensive care unit.
Academic Article
Overview
abstract
STUDY OBJECTIVES: 1. To determine the characteristics of term and preterm infants for which polysomnography (PSG) was used as a primary diagnostic tool in infants with recurrent desaturation episodes, suspected obstructive apnea or both, and the prevalence of abnormal studies. 2. To identify the interventions following PSGs. 3. To assess the added value of airway and swallow evaluations. METHODS: Retrospective cohort study of infants evaluated by PSG in the Neonatal Intensive Care Unit (NICU) at NYP-Weill Cornell from January 2012 to April 2018. RESULTS: PSGs were performed on 31 infants; 15 (48%) term and 16 (52%) preterm infants. Indications for PSG were persistent desaturations (n=24), suspected obstructive apnea (n=15), and stridor (n=2). Primary comorbid conditions were respiratory (n=11), craniofacial (n=9), airway anomalies (n=6) and neurologic (n=5). The apnea-hypopnea index (AHI) was abnormal in 30 (97%) infants. Of those, 23 (74%) were severe, seven (23%) were moderate, and normal in one (3%). Apneic events were predominantly obstructive in 23 infants and predominantly central in 6. AHI improved in all but one follow-up PSG. The PSG findings resulted in interventions in 24 (77%) infants, in addition to concomitant otolaryngology evaluations (abnormal in 20/25) and swallow studies (abnormal in 9/14). Clinical signs completely resolved in 22 (71%) infants. CONCLUSIONS: This is one of the first reports on the diagnostic value of inpatient PSGs in the NICU in infants with recurrent desaturation episodes, suspected obstructive apnea or both. Our findings indicate that PSG is an important tool in evaluating and targeting therapies in complex term and preterm infants with a wide variety of comorbidities.
