Bryanda Woods

Post Tympanostomy Observation Guidelines for Premature Infants

Authors: Bryanda Woods, MBA, Payton Erickson, BS, Peter Kfoury MD, Victoria Chiou, BS, Shilpi Kharidia, BS, Alex Lockrey, Megna Reddy BS, Albert Park MD PhD

Mentor: Albert Park, MD

Department: Otolaryngology

Abstract: Preterm birth, defined as delivery before 37 weeks of gestation, affects 8–10% of infants globally. Advances in healthcare and neonatal intensive care have significantly improved survival rates for preterm infants. However, the underdeveloped respiratory system in these infants often leads to apnea, a cessation of breathing lasting over 20 seconds or shorter durations accompanied by bradycardia, cyanosis, or pallor. Apnea monitoring for premature infants has become standard clinical practice, yet inconsistencies in definitions, monitoring protocols, and interpretations of clinical significance have resulted in significant variability in practice. This variability underscores the need for more standardized approaches to apnea management and monitoring, particularly in post-operative settings.Apnea is one of the most frequently diagnosed complications in post-operative premature infants, and its pathophysiology must be better understood to optimize clinical applications. Previous studies, such as those by Henderson-Smart (1981), revealed that apneic episodes resolve by 37 weeks postmenstrual age (PMA) in 92% of infants and by 40 weeks PMA in 98%of cases. Despite these findings, current monitoring practices often extend well beyond these benchmarks, leading to increased healthcare costs, resource use, and parental dissatisfaction.Institutions like the University of Utah Health currently require all premature infants under 60 weeks PMA who undergo anesthesia to be admitted for 12 hours of postoperative apnea monitoring, regardless of the procedure’s complexity. This policy applies to both major surgeries, such as hernia repairs, and minor procedures, such as tympanostomy tube placement. To evaluate the necessity of this policy, a systematic chart review and analysis were conducted. The study aimed to assess the impact of the monitoring period on clinical outcomes, healthcare-associated costs, and parental frustration due to extended hospital stays.Using medical billing records from 2011 and filtering through electronic medical records (EMRs) after the system transition in 2016, 18,525 patient charts were reviewed. After applying inclusion and exclusion criteria, 21 premature infants (42.7–60 weeks PMA) were included in the study group, and 48 premature infants (60.9–104.9 weeks PMA) served as controls. Both groups underwent tympanostomy tube placement. Preliminary data suggests the following, analysis is ongoing.