Home monitoring

Once at home, all parents are faced with a variety of new tasks and challenges. In case of ill babies, this is often accompanied with worry, insecurity and fear about the child. Parents should be familiar with possible critical future situations and should know how to react in specific situations. Some preterm babies need monitors and other equipment at home to check heart rate, breathing, or oxygen saturation, for example if the baby has recurrent apnoeic episodes (pauses in breathing). If a monitor is needed, the healthcare team will instruct the parents and other caregivers to take care of the baby’s special needs before discharge. Parents will also learn how to perform infant resuscitation.

Home monitors

These monitors are specially designed to monitor oxygen saturation, respiration, heart rate or pulse rate of at-risk children of all age groups and have found wide acceptance in hospitals, during transport or at home, including in the care for preterm infants and small children.

 
Apnoea monitors

Apnoea monitors are extremely sensitive alarms which monitor the breathing of a baby. Small sensors, connected to a monitoring device, are attached to the baby’s chest. If the baby stops breathing for a certain period of time, an alarm is triggered. Ideally, monitors combine apnoea alarms with heart rate- and oxygen saturation-alarms so that the number of false alarms can drastically be reduced.

These monitors can also help parents keeping an eye on their child when travelling home in a car seat after discharge, during the first days and weeks at home or in situations where intensive supervision and care are of high importance. The monitors can be used in a wide range of applications.

Inducements for home monitoring may include among others:

• SIDS-Siblings (Sudden Infant Death Syndrome siblings)
• Preterm infants, born before 33rd week of pregnancy
• Low-birth-weight infants
• Babies after ALTE (Apparent Life Threatening Event)
• Babies with instable respiration or threatening arrhythmias
• Preterm infants with significant apneas at the time of hospital discharge or needing oxygen at home
• Infants with tracheostoma
• Children with artificial respiration
• Children with conspicuous polysomnogram
• Children with drug addicted parents

Please contact your NICU-team or your paediatrician to check the individual necessity for home monitoring as well as for individual handling instructions.

Some babies may still need additional oxygen to support breathing and growth. If a baby’s lung is not working sufficiently, for example because of earlier breathing difficulties or a chronic lung disease, the health care team prescribes oxygen for home use.

Before discharge, parents are instructed in anything they need to know about oxygen supply at home. The health care team makes sure that parents are comfortable with securing the tubes for example before they take their baby home.

The paediatrician or neonatologist informs parents on how long their baby will need oxygen and observes the progress of the baby after discharge. The healthcare team also explains the amount of oxygen required and how parents can recognise signals showing that their child needs more oxygen. They also explain how to handle oxygen during daily care routines such as bathing, how to use portable oxygen when going outside, and what to take into consideration when they would like to travel.
 

Parents must never change the amount of oxygen without the advice of a health professional!

If a baby needs oxygen at home, parents may also be provided with an oxygen saturation monitor, which measures the oxygen level in the blood. According to the level of oxygen measured, the amount of oxygen can be adjusted by the paediatrician/general practitioner or the visiting nurse.

If a baby is weaned off oxygen, this usually happens gradually.

Some healthcare professionals advice to begin weaning in the daytime and then at night. At first, the amount of oxygen might be reduced step by step. Later, longer periods without additional oxygen can be introduced. The baby’s healthcare professionals will decide together with the parents about the optimal way of weaning. The time of weaning can be quite a difficult period for parents and for the baby. Parents should be well prepared and receive appropriate support to cope with this situation.