There is seldom a role for home cardiorespiratory or oxygen monitors. Even in newborns and young infants who are discharged home from neonatal intensive care units for a variety of serious conditions, including apnea and bradycardia of prematurity which resolves in the hospital, home monitors are deemed by neonatologists and pediatricians as unnecessary for most situations. For a lot of new parents, though, reassurance by expert medical providers may not provide the piece of mind necessary to quell natural anxieties. For parents who feel the intense need to monitor their infant’s vital signs — especially while they sleep — there is, says Lisa Rapaport, an app for that:

Smartphone applications paired with sensors to monitor babies’ vital signs may appeal to parents anxious to make sure infants sleep safely through the night, but there’s no medical evidence proving these products work, a new paper suggests.

These apps linked to sensors in babies’ socks, onesies, leg bands and diaper clips are marketed as tools to help parents keep tabs on things like breathing, pulse rate and oxygen levels in the blood and sound alarms when infants are in distress. But they aren’t tested or approved for U.S. sale like medical devices and there’s little evidence to suggest these monitors are safe or effective, said Dr. Christopher Bonafide, lead author of the opinion piece in JAMA.

 

The biggest downside to these devices is false alarms, which “jangle parents’ nerves” and can lead to expensive and often invasive middle-of-the-night medical interventions at the emergency room, according to Dennis Thompson:

“I worry about the unnecessary care and even potential harm to babies that can be associated with alarms from these devices,” Bonafide said. “There’s not a role for these devices in the care of healthy infants.”

One such device is Owlet Baby Care’s sensor-laden “smart sock.” It’s worn on a baby’s foot to monitor vital signs and sells for $250, according to the manufacturer.

 

Citing the lack of evidence supporting the efficacy of these high-tech baby monitors, the American Academy of Pediatrics does not endorse them for healthy infants. In fact, the AAP recommends against the use of devices that can open up an unwelcome and potentially harmful can of worms:

False alarms can occur if babies set off the monitor by kicking or rolling, or experience a harmless change in their vitals that the device reads as life-threatening, Bonafide said.

For example, research has shown that babies occasionally experience sudden declines in their blood oxygen levels that would set off a monitor, he said.

“They’re just normal fluctuations,” Bonafide said, adding that the alarm would have parents think otherwise.

Babies brought in on a false alarm are likely to undergo blood tests, X-rays and other procedures that are expensive and potentially harmful, Bonafide said.

These false alarms also fray the nerves of sleep-deprived young parents, he added.

 

When it comes down to it, all vigilant parents worry about one thing more than anything else, and that one thing is SIDS (sudden infant death syndrome). This silent event is really quite uncommon and as we discovered previously on The PediaBlog, there are steps parents can take to make this rare occurrence even rarer:

  1. Place a baby to sleep on his/her back.
  2. Babies should sleep on a firm surface, such as a crib, and NEVER on a soft surface, like a sofa.
  3. Babies should not sleep in the same bed as their parents or other children. (Babies may sleep in a crib in the same room as their parents.)
  4. Soft bedding materials — pillows, comforters or quilts — don’t belong in a baby’s crib. Soft toys should also be kept out of the baby’s sleeping area. The safest sleep environment consists solely of a firm crib mattress covered by a fitted sheet, with no bumper pads on the crib.
  5. Avoid products marketed as a way to reduce SIDS risk, such as wedges and positioners. These are marketing gimmicks that have never been tested or proven to be safe or effective.
  6. Allow babies to sleep with a pacifier (unattached to clothing with a clip and string or ribbon).
  7. Don’t smoke during and after pregnancy; prohibit exposure to secondhand tobacco smoke and avoid other forms of air pollution during and after pregnancy.
  8. Don’t drink alcohol at all during pregnancy.
  9. Breastfeed babies, exclusively if possible, for their first six months.
  10. Immunize babies completely and on-time.

 

This past November, we reviewed the AAP’s updated policy statement on SIDS prevention which included these additional ten recommendations:

  • Avoid overheating and head covering in infants.
  • Pregnant women should obtain regular prenatal care.
  • Don’t use home cardiorespiratory monitors as a strategy to reduce SIDS risk.
  • Supervised tummy time while the infant is awake can help development and minimize positional plagiocephaly.
  • There is no evidence to recommend swaddling to reduce the risk of SIDS.
  • Health care professionals and staff in newborn nurseries and neonatal intensive care units as well as child care providers should endorse and model recommendations to reduce SIDS risk.
  • Media and manufacturers should follow safe sleep guidelines in messaging and advertising.
  • Continue the Safe to Sleep campaign, focusing on ways to further reduce sleep-related deaths.
  • Research and surveillance should continue on all risk factors.
  • It is recommended that infants sleep in the parents’ room, close to the parents’ bed, but on a separate surface designed for infants, ideally for the first year of life, but at least for the first 6 months.

 

It’s the last recommendation that sent shockwaves through the pediatric medical community, reverberating in every pediatrician’s office and clinic. A few items needed clarification:

What is being recommended is room sharing, NOT bed sharing, but alone on appropriate firm and uncluttered sleep surfaces designed for infants, like cribs, bassinets, and playards (Pack ‘N Play). Armchairs and sofas are strictly forbidden as a place for infants to sleep…

Mothers who need to nurse or bottle feed their babies at night should be encouraged to lie in their own beds, without pillows and blankets, for the feeding session. In case sleepiness during nursing ensues, the mother’s bed (free of soft bedding) is a safer location for a baby than feeding in an armchair or on a sofa. Mothers are instructed to put their babies back to sleep in their appropriate sleep areas immediately after the feeding is completed.

 

At this point in time, it’s better that parents have confidence in their own low-tech capabilities and follow the AAP’s safe sleep environment policy statement recommendations rather than relying on high-tech electronic devices marketed directly to consumers that haven’t been proven effective in preventing SIDS. Maybe someday there will be a technological solution, but, for now we’re left waiting.

 

(Google Images)