A tiny new infant can cause enormous stress for parents. If that baby has apnea, defined as an abnormal pause in breathing, the situation can turn into every parent’s nightmare.

“This can be one of the most harrowing times in a parent’s life,” says Anthony Orsini, MD, director and founder of the Tri-State Infant Apnea Program, a division of Millennium Health Care in Livingston, NJ.

Babies go home from the hospital on apnea monitors for a number of reasons. They may be premature and are still very small, they may have been diagnosed with apnea, or perhaps they are siblings of SIDS (sudden infant death syndrome) babies. Once home, the level of support available to parents is directly dependent on their apnea program. The one offered by Tri-State is all-encompassing, making it markedly different.

“Other apnea programs usually are affiliated with hospitals. This is the only one that incorporates not only the nurses and practitioners that you’d get with a hospital-based program, but also the DME provider. Other apnea programs have to rely on an outside DME company,” Orsini says.

The need for such a program has increased as managed care dictates that hospitals send premature babies home earlier and at lower birth weights. Orsini, who developed a similar program at New York University before designing the Tri-State program, says that as many as 90% of the infants in his program are 6 to 12 weeks premature. Some hospitals send virtually all their premature infants home with an apnea monitor.

“One of the biggest contributors to parental stress when using an apnea monitor is the learning curve,” Orsini says. “The first two or three nights the baby is home, the mother gets a lot of alarms, which in most cases are false alarms because she’s using the monitor incorrectly or at the wrong time.”

Hospitals usually tell parents their babies need monitoring because the infants are more likely to stop breathing than normal babies. When the alarm goes off, these already nervous parents feel helpless because there is no guidance in the middle of the night to help them determine if the alarm is false or real. They end up at the emergency department, where the baby is admitted. At this point parental stress goes off the charts, Orsini says. It is the reason why apnea monitors sometimes have a bad reputation among physicians.

A complete apnea program, on the other hand, supplies support and instruction 24 hours a day. Within a day of bringing an infant home, a nurse practitioner will call the parents. He or she will call again weekly during the entire time the baby is on the monitor. Within the Tri-State program a parent with an infant on an apnea monitor has just one number to call to immediately reach a trained professional at any time.

“In many cases we can troubleshoot over the phone,” Orsini says. “If we can’t, we do a download of the modem through the telephone line even if it’s 3 am. We have the software and the expertise to read it. We’ll be able to reassure the mother that the alarms aren’t real, and tell her what she’s doing wrong.”

To download, the parent takes the baby off the monitor and hooks one end of the modem to the telephone line and the other to the monitor. The physician instructs the parent not to answer the phone, then calls the parent’s phone number. The computer modem answers the phone and transmits data to the physician’s home or office computer in waveforms, which the monitor creates each time the alarm goes off. It saves data from 30 seconds before the alarm goes off to 15 seconds after, and retains a waveform of the baby’s breathing and heart rate. The physician can look at the waveforms and determine if the alarms were real or false.

Finding, educating, and retaining the top-notch apnea staff necessary for this program is a challenge. Nurses and nurse practitioners must have finely honed clinical skills as well as knowledge of family dynamics and psychology. An essential quality in any practitioner in Tri-State’s program is that he or she must enjoy working with families. Orsini says there are a handful of physicians, mostly neonatologists and pediatricians plus a few pulmonologists, who are knowledgeable in apnea programs, and even fewer nurses. When hired, Tri-State’s nurse practitioners all are neonatal intensive care nurses. Orsini then provides further training regarding apnea.

Insurance companies and other third-party payors acknowledge that a complete infant apnea program means more cost-effective treatment and better outcomes. When a discharge planner or physician’s office calls for authorization, many insurers recommend Tri-State’s program.

Orsini says compliance also goes up with a complete program versus a nonmonitored program, and insurers have discovered that parents with a child in a complete apnea program make fewer false alarm trips to the emergency department.

In addition, because babies in the program are managed and followed so carefully, they generally are off monitors at around 11 to 12 weeks, rather than the 9-month average length of monitoring for a baby not in a program, Orsini says. Perhaps the best news is that follow-ups on the babies’ first birthdays show that 85% of parents were happy with the program, and believed their stress levels actually decreased because of it.

Although the Tri-State program is financially successful, there are few similar programs because a company must do a high volume of business to stay afloat. Overhead is high and nurse practitioners and 24-hour monitoring are costly.

The Tri-State Infant Apnea Program currently manages babies in New York and New Jersey, and soon will extend service to Pennsylvania and Delaware. However, it has no plans to extend the service nationwide. Instead, Orsini says his mission is to continue to educate payors, referral sources, and parents on the advantages of a complete apnea program.

Judy Wade is a contributing writer for Dealer/ Provider. For more information, visit Millennium online at www.milleniumhomecare.com.