Two peripherally related articles:
Elder DE, Campbell AJ, Galletly D: Current definitions for neonatal apnoea: Are they evidence based? Journal of Paediatrics and Child Health 2013. A review of the different available definitions for apnea, and the lack of an evidence base for any of them, particularly the very common limit of 20 seconds. With the data about recurrent hypoxia becoming more concerning, this needs to be re-assessed, what can we do about detecting and intervening for apnea. How long is too long, or does the duration matter at all? If we change the definition, can we intervene more quickly to prevent desaturation?
But if we shorten the duration we will get more alarms, and many are already missed or ignored: Brockmann PE, Wiechers C, Pantalitschka T, Diebold J, Vagedes J, Poets CF: Under-recognition of alarms in a neonatal intensive care unit. Archives of Disease in Childhood – Fetal and Neonatal Edition 2013. Desaturation to less than 80% and bradycardia to less than 80 were documented by continuous recording. Comparison with the nurses record showed that about 23% of the desats and 60% of the bradys were documented. Even if the spell was bad enough for the nurse to intervene, or if the apnea lasted more than 20 seconds, the documentation was not reliable.
If we want to shorten the apnea duration, we will get more alarms, and even less documentation, we will have to prove that there is some benefit to offset the increase in workload and frustration that this will cause.