Caregiver’s response to cardiorespiratory events in preterm infants in the NICU – a quantitative overview

Abstract Purpose Cardiorespiratory events in preterm infants form a major challenge in the Neonatal Intensive Care Unit (NICU) as they require a prompt response. We aimed to describe caregivers’ responses to these events. Methods We performed a prospective observational study using video recording of the inside of the incubator prompted by cardiorespiratory alarms in 19 preterm infants born at 28 weeks (± 2 weeks) gestational age receiving non-invasive respiratory support. Alarms were labelled as isolated or clustered, and subsequently classified as apnoea, bradycardia, desaturation and oxygenation events or a combination of these. Caregivers’ responses to these events were then identified from the videos. Results 1851 cardiorespiratory events were recorded with a median duration of 11.0 (5.0-23.0) seconds. No response was observed in the majority of the events (91.5%). In the remaining 8.5% events, caregivers responded by pausing the alarm, adjusting devices and/or providing tactile stimulation with an average response time of 25.4 (13.8-35.9) seconds. Stimulation was the most observed response and was applied in 38 different ways. On average, stimulation lasted 18.7 (11.6-44.6) seconds and the cardiorespiratory events were resolved 30.6 (19.5-47.6) seconds after stimulation started. Conclusions Our study showed that cardiorespiratory events occur often in preterm infants in the NICU, but are most often not followed by intervention of the caregiver. The indication, timing and execution of responses to cardiorespiratory events is highly variable.