Apnea in preterm infants remains one of the most complex and monitored conditions in neonatal care, yet consensus on its precise definitions and optimal monitoring strategies continues to provoke debate. In a recent correction to a pivotal scoping review published in Pediatric Research, Jeanne, Lv, Sénéchal, and colleagues have sought to clarify foundational aspects of apnea among this vulnerable population. This comprehensive update underscores the evolution of apnea characterization methodologies, emphasizing the need for uniformity in clinical and research frameworks that could reshape neonatal monitoring practices worldwide.
Apnea, broadly understood as a pause in breathing lasting more than a defined period, manifests uniquely in preterm infants due to their immature neurological and respiratory systems. The review highlights the diagnostic variability that historically stems from inconsistent apnea definitions, complicating clinical decision-making and research interpretations alike. Spanning numerous studies and clinical trials, this corrected article meticulously dissects the parameters used to define apnea—the duration thresholds, the consideration of accompanying bradycardia or oxygen desaturation, and differing monitoring hardware sensitivities.
At the heart of the discussion is the challenge of balancing sensitivity and specificity in apnea detection. Conventional monitoring techniques, including thoracic impedance and pulse oximetry, can generate false positives and negatives, which may lead to either unnecessary interventions or overlooked critical events. The article stresses that evolving sensor technology and signal processing algorithms offer promising avenues to enhance detection accuracy but must be standardized to gain broad applicative legitimacy.
Equally significant is the role of comprehensive monitoring that integrates data streams to contextualize apnea episodes. Advances in multimodal monitoring allow simultaneous observation of respiratory activity, heart rate variability, and oxygen saturation, facilitating richer datasets that inform both acute management and longitudinal prognoses. The authors argue that such integrative approaches are essential in transitioning from reactive responses to proactive, precision medicine paradigms in NICUs (Neonatal Intensive Care Units).
In addition to hardware concerns, the scoping review correction explores how the subjective evaluation of apnea episodes by medical staff introduces variability. The intricate interplay of algorithmic detection and clinician interpretation can differ widely between institutions. This discrepancy affects not only treatment thresholds but also hampers multicenter research studies aimed at identifying correlations between apnea severity and long-term neurodevelopmental outcomes.
Importantly, the scoping review reaffirms that apnea is not merely an isolated respiratory event but a complex, multifactorial syndrome influenced by developmental physiology, comorbidities, and external environmental factors. Understanding apnea within this broader biological context is critical for tailoring effective interventions and minimizing potential adverse sequelae such as hypoxic injury and developmental delays.
The article also critically reviews ambulatory and home monitoring solutions, weighing their potential benefits against logistical challenges. As neonatal care increasingly embraces outpatient management, reliable apnea monitoring outside hospital settings could revolutionize follow-up care. However, achieving this requires rigorous validation of portable devices to prevent both alarm fatigue and missed critical events.
From a research methodology perspective, the correction outlines the imperative of uniform reporting standards in apnea studies. It calls for international consensus on apnea definitions and monitoring protocols to enable meta-analyses, foster reproducibility, and accelerate the translation of research findings into clinical guidelines. Such harmonization would also facilitate regulatory approvals for new monitoring technologies and therapeutic interventions.
The review dedicates attention to the physiological mechanisms underlying apnea episodes, discussing central, obstructive, and mixed types. Central apnea, stemming from immature respiratory drive, contrasts sharply with obstructive apnea, related to airway patency issues. The overlap and transition between these forms challenge monitoring algorithms, requiring increasingly sophisticated differentiation techniques based on respiratory effort, airflow, and neural signals.
Jeanne et al. further explore the implications of apnea monitoring on therapeutic strategies. They examine how the detection of periodic breathing patterns influences decisions regarding pharmacological treatments like caffeine citrate, respiratory support modalities, and the timing of discharge readiness. The nuanced understanding of apnea phenotypes could personalize therapy, enhancing outcomes while reducing unnecessary interventions.
Ethical considerations arise in monitoring apnea, particularly concerning alarm management and parental involvement. The review advocates for systems that minimize false alarms to reduce stress on infants and caregivers while maintaining sufficient vigilance. It also highlights the importance of clinician training and the integration of apnea data into broader patient safety frameworks.
Technological innovation is another focal point. The correction underscores the potential of machine learning and artificial intelligence to analyze complex apnea-related datasets. These tools can identify subtle patterns predictive of clinical deterioration or neurodevelopmental risks, opening new horizons for early intervention and personalized care pathways.
Supporting evidence from physiological monitoring research highlights the importance of continuous oxygen saturation and heart rate recording, particularly during sleep when apnea is most prevalent. The authors note ongoing studies that leverage high-fidelity signal acquisition to refine apnea episode classification and correlate these with clinical outcomes.
Finally, this corrected scoping review concludes with a call to action for the neonatal research community. It stresses the urgency of concerted efforts to standardize apnea definitions and monitoring approaches globally, recognizing that such progress is foundational for reducing morbidity and mortality in preterm infants—arguably one of modern neonatology’s most pressing challenges.
By rigorously addressing the technical, clinical, and ethical dimensions of apnea monitoring, Jeanne, Lv, Sénéchal, and colleagues illuminate a path forward that promises to unify research efforts and optimize newborn care. This landmark work signals a pivotal moment, heralding a future where apnea in preterm infants is not just detected, but understood and managed with unprecedented precision.
Subject of Research: Definitions and monitoring methods for apnea in preterm infants
Article Title: Correction: Definitions and monitoring methods for apnea in preterm infants: a scoping review
Article References:
Jeanne, E., Lv, S., Sénéchal, E. et al. Correction: Definitions and monitoring methods for apnea in preterm infants: a scoping review. Pediatr Res (2025). https://doi.org/10.1038/s41390-025-04678-7
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