Newborn Nursery Attending Pediatrician Stanford School of Medicine Stanford University Stanford , California, United States
Background: Newborn infants experience many transitions, including brief dusky episodes concerning for cyanosis. Newborn providers must assess infants to decide if these events are clinically significant. In contrast to apnea of prematurity and brief resolved unexplained events, scarce data exists to guide providers about newborn dusky events occurring during the birth hospitalization. Our hospital developed a newborn brief resolved cyanotic event clinical care pathway to guide care. Objective: 1) Determine whether newborns who undergo cardiorespiratory monitoring after cyanotic events while hospitalized have an increased rate of NICU transfer compared with other newborns. 2) Determine whether the following variables predict transfer to NICU care: gestational age, delivery mode, association with emesis, birth weight, and hour of life event occurred. Design/Methods: During the birth hospitalization, parents or providers reported cyanosis. If notified of a cyanotic event, on-call physicians decided whether to admit the infant for cardiorespiratory monitoring (recommended by care pathway). We conducted a retrospective chart review of newborn infants who had 1-4 hours of cardiorespiratory monitoring after a brief cyanotic event. We excluded infants who had events the first 2 hours after delivery. Chi-Square Test was used to evaluate differences in NICU transfer rates. Logistic regression was used to determine association with gestational age, delivery mode, emesis, birth weight, hour of life event occurred and need for NICU transfer. Results: Infants who were monitored for cyanotic events had a significantly higher level of transfer to NICU than other newborns. During a 31-month period, 52 of the 11,198 infants (0.5%) were monitored due to cyanosis. Among this group, 21% transferred to NICU. This percentage differed significantly from the baseline rate of NICU transfer (5%) among newborns (chi square=31.06, P< .00001). Multivariate logistic regression showed NICU transfer for cyanosis was not related to delivery mode, vomiting, gestational age, hour of life of cyanosis, or birth weight. Diagnoses for transferred infants included aspiration, hypoxia, hypoglycemia, apnea of prematurity, and oral-pharyngeal dysphagia.
Conclusion(s): Newborns who experienced a brief cyanotic event during the birth hospitalization and were monitored for 1-4 hours afterward had a significantly increased rate of NICU transfer compared with other newborns. In our small cohort, we did not find predictors of need for transfer, but there was more of an association between gestation age < 38 weeks gestation and requiring increased level of care.
