Home Monitors Don't Appear to Predict SIDS

Reviewed by Tonja Wynn Hampton, MD on May 01, 2001
From the WebMD Archives

May 1, 2001 -- Proper positioning of babies when they sleep -- not the use of home monitors -- still appears to be the best way to prevent sudden infant death syndrome (SIDS), or "crib death," experts say.

"For a long time it has been recognized that certain infants are at risk for SIDS," George Lister, MD, tells WebMD. "We have also realized that many of these infants have episodes when they stop breathing or their heart rate decreases to what seems to be a dangerously low pace. The idea has been that if they were monitored at home with devices capable of counting the duration of these episodes and sounding an alarm, the warning would interfere with the event and save the child from sudden death."

But Lister says that hope, which is supported by a flourishing industry of home monitoring manufacturers, does not appear to be borne out.

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A large study of home monitors designed to prevent SIDS found that many of the heart and breathing irregularities that set off monitor alarms -- and which may be precursors to crib death -- occur commonly both in healthy and in at-risk infants.

What's more, those irregularities don't appear to be related to SIDS, according to a report appearing in the May 2 edition of TheJournal of the American Medical Association.

Lister, an author of the report, tells WebMD that the study sheds some doubt on the usefulness of home monitors in predicting or preventing SIDS.

"What we found is that not only were the events currently being detected by monitors very, very common, they were occurring in healthy infants as well as infants at risk," Lister, a professor of pediatrics at Yale University School of Medicine in New Haven, Conn., tells WebMD.

In the study, nearly 1,000 infants -- including healthy babies and babies born prematurely -- were observed using home monitors for the first six months after birth. The babies had no or varying degrees of risk for SIDS.

The monitors were used to detect episodes of apnea -- or a sudden halt in breathing lasting at least 20 seconds -- as well as decreases in heart rate. Researchers also used a specially designed monitor to detect "extreme events" -- more severe apnea and more severe decreases in heart rate -- not commonly detected by commercial monitors.

The results showed that there were nearly 7,000 events that would have caused a conventional commercial monitor to sound the alarm, occurring in 41% of all the infants. Even the "extreme" events, though far more common in preterm infants, were fairly frequent in both healthy infants and infants at risk for SIDS.

Because only six infants in the study died from SIDS, the study cannot be used to determine an association between the events and risk for death. But Lister points out that the extreme events tended to occur very early in infants' lives -- much earlier than SIDS typically occurs. SIDS rarely occurs before one month of age. It is most likely to occur when infants are 2-4 months old, with 95% of cases occurring by 6 months of age.

For that reason, he says, even the extreme events do not appear to predict which babies will succumb to SIDS. "These extreme events may represent vulnerability for some later problems, but they are unlikely to be the immediate precursor to SIDS," he tells WebMD. "If they did, you would expect a lot more kids with SIDS [immediately following the extreme events]."

In an editorial accompanying the report, Alan H. Jobe, MD, PhD, notes that approximately 20,000 preterm infants are sent home every year with monitors at a cost of approximately $24 million per year. He says that although the study was not designed to test the usefulness of home monitors to prevent SIDS, the study results in more doubt than ever before on such a practice.

Jobe is with the division of pulmonary biology at Children's Hospital Medical Center in Cincinnati.

Pediatrician Michael Malloy, MD, says the results come as no surprise. "They confirm previous research showing that monitoring is not the way for us to go about preventing SIDS," Malloy tells WebMD.

He is professor of pediatrics at the University of Texas Medical Branch in Galveston and a member of the American Academy of Pediatrics' (AAP) Task Force on Infant Positioning and SIDS.

So what can parents do to prevent SIDS?

Malloy suggests the best prevention is proper bedding and, most important of all, placing infants on their back when they sleep. "At this point, it appears we have had some impact [on SIDS] with the Back-to-Sleep Campaign," Malloy tells WebMD.

Back-to-Sleep is the AAP's nationwide campaign encouraging parents to place their babies on their backs, and not to let infants sleep face down, in the so-called "prone" position.

A policy statement released last year by the AAP's Task Force on Infant Positioning and SIDS stated: "There is no evidence that home monitoring with such monitors decreases the incidence of SIDS. Furthermore, there is no evidence that infants at increased risk of SIDS can be identified by in-hospital respiratory or cardiac monitoring."

That report included a number of recommendations for how to prevent SIDS. Among them are the following:

  • Infants should be placed for sleep in a nonprone position. While side sleeping is not as safe as sleeping on the back, it is safer than sleeping face-down. If the side position is used, caretakers should be advised to bring the arm that is underneath the side-sleeping infant forward, to lessen the likelihood of the infant rolling to the prone position.
  • Parents should use a crib that conforms to the safety standards of the Consumer Product Safety Commission.
  • Parents should not place infants on waterbeds, sofas, soft mattresses, or other soft surfaces. Also, loose bedding, such as blankets and sheets, may be hazardous. If blankets are to be used, they should be tucked in around the crib mattress so the infant's face is less likely to become covered by bedding.
  • Bed sharing or co-sleeping may be hazardous under certain conditions. As an alternative to bed sharing, parents might consider placing the infant's crib near their bed to allow for more convenient breastfeeding and parent contact. Parents who choose to bed share with their infant should not smoke or use substances, such as alcohol or drugs, that may impair arousal.
  • Overheating should be avoided. The infant should be lightly clothed for sleep, and the bedroom temperature should be kept comfortable for a lightly clothed adult.

The full report of the AAP Task Force is available online at