Apnea, Bradycardia and Desaturation Spells in Premature Infants – Impact of a Protocol for Duration of “Spell-Free” Observation on Inter-Provider Variability and Readmission Rates

OBJECTIVE: To study the impact of implementing a protocol to standardize the duration of observation in preterm infants with apnea/bradycardia/desaturation spells before hospital discharge on readmission rates and length of stay (LOS). STUDY DESIGN: A protocol to standardize the duration of in-hospital observation for preterm infants with apnea, bradycardia and desaturation spells who were otherwise ready for discharge was implemented in December 2013. We evaluated the impact of this protocol on the LOS and readmission rates of very low birth weight infants (VLBW). Data on readmission for apnea and apparent life-threatening event (ALTE) within 30 days of discharge were collected. The pre-implementation epoch (2011-2013) was compared to the post-implementation period (2014-2016). RESULTS: There were 426 and 368 VLBW discharges before and after initiation of the protocol during 2011-2013 and 2014-2016 respectively. The LOS did not change with protocol implementation (66±42 vs. 64±42 days before and after implementation of the protocol respectively). Inter-provider variability on the duration of observation for apneic spells (F-8.8, p=0.04) and bradycardia spells (F-17.4, p<0.001) decreased after implementation of the protocol. The readmission rate for apnea/ALTE after protocol decreased from 12.1% to 3.4% (p=0.01). CONCLUSIONS: Implementing an institutional protocol for VLBW infants to determine the duration of apnea/ bradycardia/ desaturation spell-free observation period as recommended by American Academy of Pediatrics clinical report did not prolong the LOS but effectively reduced inter-provider variability and readmission rates.