Sudden
Infant Death
Syndrome
in Infants
Evaluated
by Apnea
Programs
in California
Sally
L. Davidson
Ward,
MD, Thomas
G. Keens,
MD,
Linda
S. Chan,
PhD,
Bradley
E. Chipps,
MD, Stephen
H. Carson,
MD,
Douglas
D. Deming,
MD, Vijaya
Krishna,
MD, Hugh
M. MacDonald,
MD,
Gilbert
I. Martin,
MD, Keith
S. Meredith,
MD, T. Allen
Merritt,
MD,
Bruce
G. Nickerson,
MD, Ronald
A. Stoddard,
MD, and
Andre
L. van der Hal, MD
From the Childrens Hospital of Los Angeles and University of Southern California School of Medicine, Los Angeles, San Diego, Sacramento, Loma Linda, Oakland, Van Nuys, and Travis Air Force Base
ABSTRACT. Home apnea/bradycardia monitoring is fre-quently used in the management of infants at increased risk for sudden infant death syndrome (SIDS). However, some infants have died despite evaluation by infant apnea programs, and the benefits of home monitoring remain unproven. To determine the SIDS rate and risk factors of infants evaluated by infant apnea programs, 31 apnea programs and ten home monitor vendors in California were surveyed. Eleven (35%) of the apnea programs and four (40%) of the vendors responded. Information was obtained on 26 infants who died. Thirteen (50%) deaths were due to SIDS. Abnormal sleep studies did not predict death. Fifteen infants died despite a recommendation for home monitoring. Seven deaths occurred in association with technical errors or noncompliance with monitoring. Four deaths were due to nonaccidental trauma. The ap-nea programs evaluated 3,406 infants during a 5-year period; 1,841 had monitoring recommended. Term in-fants with apnea, subsequent siblings of SIDS victims, and infants evaluated at referral centers were more likely to have monitoring recommended than premature infants with apnea or infants evaluated at nonreferral centers (P < .0001). Infants who had monitoring recommended were at equal risk of dying of SIDS as those who did not.
Pediatrics 1986;77:451-455; sudden infant death syn-drome, home monitoring, infant apnea, apnea of prema-turity, sibling.
Sudden infant death syndrome (SIDS) is the
most common cause of death in infants between
Received for publication July 1, 1985; accepted Sept 16, 1985. Reprint requests to (T.G.K.) Childrens Hospital of Los Angeles, Division of Neonatology and Pediatric Pulmonology, 4650 Sun-set Blvd, Los Angeles, CA 90027.
PEDIATRICS (ISSN 0031 4005). Copyright © 1986 by the American Academy of Pediatrics.
the ages of 1 month and 1 year.’5 Because the
causes of SIDS are unknown and the SIDS victim
cannot be accurately identified prior to death, SIDS
cannot be prevented.6 However, several groups of
infants have been described as being at increased
risk for SIDS. These groups include term infants
with unexplained apnea,7’1 premature infants,’2”3
and subsequent siblings of SIDS victims.’4”5
Recently, evaluations of respiratory control,
res-piratory stimulants, and home apnea/bradycardia
monitoring have been used in the management of
these infants in an attempt to reduce their risk of
SIDS.8” These techniques are based on the theory
that prolonged apnea may culminate in a SIDS
death.’6”7 Management has increasingly consisted
of home monitoring for apnea and bradycardia.
Caretakers are trained to respond to monitor
alarms with specific interventions aimed at reviving
the baby. The impact of these strategies on
pre-venting deaths in these high-risk groups is
un-known, and home apnea/bradycardia monitoring,
although widely practiced, remains controversial.6
Some infants evaluated and managed by infant
apnea programs offering home apnea/bradycardia
monitoring have died despite these efforts.’#{176}
Pre-vious reports have stressed technical difficulties as
the reason for the failure to prevent these deaths.8
It is possible that advances in monitoring
tech-niques have resulted in fewer deaths in recent years.
However, some infants have died when monitoring
technique and caretaker response to alarms were
performed correctly.9”#{176}”8 This study attempts to
identify the characteristics of those infants who
It is hoped that this will increase our understanding
of the outcome of infants at highest risk for SIDS
and possibly identify risk factors.
METHODS
A questionnaire was sent to 31 programs in
Cal-ifornia identified as caring for large numbers of
infants who are at increased risk of dying of SIDS.
Six of the programs (19%) were large
university-affiliated referral centers. Nine (29%) were
hospi-tal-based nonreferral centers mainly caring for
pa-tients presenting to their hospital. The remaining
16 (52%) were smaller private practice infant apnea
programs affiliated with community hospitals,
mostly caring for less than 100 infants in the past
4 years.
The questionnaire contained general questions
regarding the date the program began and the
num-ber of patients evaluated as term infants with
ap-nea, as premature infants with apnea, and as
sub-sequent siblings of SIDS victims from 1980 to 1984.
Term infants with apnea were defined as those with
a convincing history of an apparent life-threatening
event characterized by a color change (cyanosis or
pallor), tone change (limpness), and apnea that
required resuscitation or vigorous stimulation.7
After a diagnostic evaluation, these infants were
categorized as having either unexplained apnea, if
no cause was found, or apnea with a treatable
etiology. It is the practice of all infant apnea
pro-grams in the survey to recommend home
monitor-ing for term infants with unexplained apnea.
Sub-sequent siblings of SIDS victims were defined as
infants with one or both parents having lost a
previous child to SIDS. The diagnosis of SIDS in
the previous child was made on the basis of autopsy
results. Apnea ofprematurity was defined as infants
presenting with apnea at less than 37 weeks’
ges-tational age. The number of patients from each
group for whom monitoring was recommended and
criteria for monitoring and discontinuing
monitor-ing were requested.
The questionnaire also asked for specific
infor-mation about each infant evaluated by the program
between 1980 and 1984 who had subsequently died.
This included the diagnostic category, diagnostic
evaluation, therapy prescribed, parental
compli-ance, circumstances surrounding the death, and
cause of death. Similar questionnaires were sent to
ten vendors of home apnea/bradycardia monitors
in California in order to increase the sample size
when examining characteristics of infants who died.
The overall mortality rate of patients evaluated
by the infant apnea programs and the mortality
rate for SIDS only were calculated and compared
between those exposed and those not exposed to
each risk factor. In this study, the factors evaluated
included the presence of apnea in term infants,
being a sibling of a SIDS victim, apnea of
prema-turity, a recommendation for monitoring, being
cared for in a referral center, and the use of
the-ophylline for infants with apnea or prematurity.
The 95% confidence limits for the death rates
were obtained by assuming that the relatively rare
occurrence of deaths follows a Poisson
distribu-tion.’9 Although the statistical significance of the
difference of two death rates can be determined
when the 95% confidence intervals do not overlap,
it is possible that there is a significant difference
between the means when two 95% confidence limits
overlap.20 Therefore, the probability of each
ob-served number of deaths and its extreme cases was
derived based on the Poisson distribution with
ex-pected number of deaths when no difference
be-tween the groups is assumed.21 This allowed the
determination of the significance of the relative
risk for each risk factor.
RESULTS
Eleven of 31 (30%) infant apnea programs and
four of ten (40%) monitor vendors responded to the
questionnaire. The referral centers had the highest
response rate, followed by hospital-based
nonrefer-ral centers and private practice programs, as shown
in Table 1.
One infant apnea program and all of the monitor
vendors who submitted their results were unable to
provide information regarding total numbers of
in-fants evaluated in each diagnostic category. Their
reports were, therefore, not included in the evalu-ation of the risk factors but were used in the general
descriptions of the infants who died. Data on deaths
that had been monitored for reasons unrelated to
apnea or the risk of SIDS, such as infants with
chronic fatal underlying conditions, were excluded
from analysis.
Characteristics
of Infants
Who Died
Characteristics of the 26 infants who died are
presented in Table 2. There were 13 documented
TABLE 1. Respo nses of Infa nt Apnea Pr ograms to the Survey*
Settings Total No. Surveyed
No. Responding
% Responding
Referral centers 6 4 66.7
Hospital based, 9 3 33.3
nonreferral
Private practice 16 4 25.0
Total 31 11 35.5
* Bartlett’s test using the exact mean and variance of the
TABLE 2. Infant Deaths in Apnea Programs and Vendor Programs in California*
Type of Cases No. of Total Deaths No. Male % Fe No. male % Age at (m Mean Death o) SD
Any type 26 16 61.5 10 38.5 4.8 2.7
SIDS deaths Non-SIDS deaths 13 13 6 10 46.2 76.9 7 3 53.8 23.1 4.8 4.9 3.0 2.5
Term infants with apnea All others 7 19 5 11 71.4 57.9 2 8 28.6 42.1 5.7 4.6 4.3 2.1 Preterm All others 16 10 9 7 56.2 70.0 7 3 43.8 30.0 4.8 4.8 2.2 3.6 SIDS siblings All others 5 21 4 12 80.0 57.1 1 9 20.0 42.9 4.7 4.9 2.3 2.9
* None of the sex distributions by Fisher exact tests were statistically significant and none
of the differences of the average age at death by the two-sample t tests were statistically significant.
TABLE 3. Causes of Death of Patients Evaluated by
Infant Apnea Programs and Vendor?
Causes of Death Total Term Pre- Sibling No. of Infants term of SIDS infants with In- Victims
Apnea fants
SIDS 13 6 6 1
Nonaccidental trauma 4 1 2 2
Accidental trauma 1 1 1
Subarachnoid hemor- 1 1
rhage
Cardiac disease 1 1
Sudden unexpected 6 6
death at home, no autopsy reported
Total no. of deaths 26 7 16 5
* Two preterm infants, one dying of nonaccidental
trauma and the other of accidental trauma, were also
subsequent siblings of SIDS victims.
deaths due to SIDS. Sixteen infants who died were
male; ten were girls. Sixof the male infants died of
SIDS; seven of the female infants died of SIDS.
The
causes
of death
for all infants
are
shown
in
Table
3. All
deaths
occurred
either
at home,
in
hospital emergency rooms, or in intensive care units
shortly after transport from home.
Infants with underlying disorders that have a
high mortality were excluded from analysis. For
example,
infants
with
neuromuscular
disease
and
infants with chromosomal abnormalities were
ex-cluded from analysis. However, infants with other,
less severe, medical conditions were included. Eight
of 16 premature infants had bronchopulmonary
dysplasia or a history of respiratory distress
syn-drome.
Three
monitored
term
infants
with
apnea
had other disorders: one with a history of birth
asphyxia,
one
with
birth
trauma,
and
one
with
gastroesophageal reflux and aspiration. All three of
these infants had an autopsy report of SIDS.
The
mean
gestational
age (±SD)
at birth
of the
premature infants who died was 30 ± 3 weeks. The
mean postconceptional age (±SD) at death was 42
± 6weeks. No premature infants died of SIDS after
56 weeks’ postconceptional age (4 months corrected
age).
Of the
26 infants
who
died,
15 had
monitoring
recommended at the time of death. Seven of these
had a report of noncompliance or a technical error
in monitoring at the time of death. Two families
refused or discontinued monitoring against the
phy-sician’s advice. Three infants were off the monitor
at the time of death: one during a car trip, one
following a bath, and one napping in the parents
bed. One infant’s monitor was nonfunctional, and
the child was unmonitored during the night of
death. In one instance, the caretakers slept through the monitor alarm.
Twenby-one infants who died (81%) were
evalu-ated by sleep studies, either pneumograms or
poly-somnography.2225 Ten had at least one abnormal
study and six of these died of SIDS. Eleven infants
who died had no abnormal test results and five of
these died of SIDS. The cross-tabulation of the
results of sleep studies and types of deaths is shown
in Table 4.
General
Characteristics
of Infant Apnea
Programs
The ten infant apnea programs that completed
the questionnaire fully have evaluated 3,406 infants
for either term apnea, apnea of prematurity, or a
positive family history of SIDS. Of the infants
evaluated, 1,841 (54%) were placed on home apnea/
greater percentages of term infants with apnea and
subsequent siblings of SIDS victims were
moni-tored than were preterm infants evaluated for
ap-nea
(P < .0001). When monitoring wasrecom-mended, all programs used combined
apnea/brad-ycardia monitors. Referral centers recommended
monitoring for a significantly higher proportion of
infants (P < .0001). Sleep studies, either
pneumo-grams (overnight recordings of ECG and
respira-tory rate) or polysomnography were usually
per-formed in all three groups of infants. An abnormal
study was rarely required to make the diagnosis or
to institute home monitoring in either the term
apnea
or the
subsequent
sibling
group.
Preterm
infants were frequently required to have an
abnor-mal sleep study before home monitoring was
rec-ommended. About half of the programs used
the-TABLE 4. Sleep Studies and Types of Infant Deaths*
Types of Infant Deaths Total No.
No. (%) of Infants in Whom Sleep Study Results
Were:
Normal Abnormal
All deaths 21 11 10 (47.6)
SIDS deaths Non-SIDS deaths
11 10
5 6 (54.5) 6 4 (40.0)
Term infants with apnea All others
5
16
2 3 (60.0) 9 7 (43.8)
Preterm infants All others
13
8
8 5 (38.5)
3 5 (62.5)
Sibling of SIDS victims
All others
5 16
3 2 (40.0) 8 8 (50.0)
* The percentage of infants with abnormal sleep study
results for the different causes of death or diagnostic
categories were not statistically significant.
ophylline or caffeine in the management of
pre-mature infants with apnea. About one third of
programs used theophylline for term infants with
apnea. Rare use of theophylline was reported by
two programs for subsequent siblings of SIDS
vic-tims.
The criterion
for discontinuing
home
monitoring
for all programs was 2 to 3 months without an
apparent life-threatening event for all three
diag-nostic categories. Other criteria frequently used by
most programs were normal sleep studies and
suc-cessful weathering of a physical stress (such as an
upper
respiratory
tract
infection)
without
events.
Asymptomatic siblings of SIDS victims were
mon-itored until they passed the age of death of the
previous SIDS victim.
Relative
Risks of Mortality
There were 17 deaths reported by apnea
pro-grams among the 3,406 infants evaluated. Eleven
of these were related to SIDS. A comparison of the
overall mortality rates per 1,000 infants evaluated
for each risk factor, comparing the group at risk
with the group not at risk, is shown in Fig. 1. Similar
data for deaths due to SIDS only are shown in Fig.
2.
There was no significant difference in the overall
mortality between the infants exposed to a risk and
those not exposed for any risk factor. The overall
death rate of those who had monitoring
recom-mended was essentially the same as those who did
not. To assess any bias introduced by the higher
percentage
of referral
centers
responding
to the
survey, evaluation of an infant by a referral center
was considered as a separate risk factor. There was
no significant
difference
between
the overall
death
rate from infants evaluated at referral centers and
TABLE 5. Recommended Home Monitoring by Risk Groups*
Risk Groups Total No. of Infants
No. (%) on Home Monitor
No. Not on Home Monitor
Total infants 3,406 1,841 (54.1) 1,565
Term infants with apnea
All others
1,526 1,880
980 (64.2) 911 (48.5)
546 969
Preterms All others
1,509 1,897
594 (39.4) 1,297 (68.4)
915 600
Siblings of SIDS victims All others
371 3,035
267 (72.0) 1,624 (53.5)
104 1,411
Referral centers
Nonreferral centers
2,116 1,290
1,338 (63.2) 503 (39.0)
778
787
* Higher proportions of term infants with apnea and siblings of SIDS victims were
Total Deaths
Per
1000
Infants Evaluated
J
Exposed To Risk FactorEJ
Not Exposed To Risk FactorI
ass Confidence IntervalsI
Siblings
Term
[1
Risk Factor
Fig 1. Total
death
rates and 95% confidence intervals by risk groups. There were no significant differences in total death rates for those exposed u those not exposed to eachrisk factor based on Poisson distribution.
U
Exposed To Risk Factorc:
Not Exposed To Risk FactorI
ass Confidence IntervalsSIDS
Per 1000 Infants Evaluated
Term SIDS Siblings Preterm
Risk Factors
Fig
2.Sudden
infant death syndrome (SIDS) death rates and 95% confidence intervalsby risk groups. There were no significant differences in SIDS death rates for those exposed V those not exposed to each risk factor based on Poisson distribution.
those
cared
for by other
programs.
Similarly,
there
risk factors.
were no statistically significant differences when Because the use of theophylline for premature
SIDS
deaths
alone
were
considered
for each
of the
infants
varied
widely
between
the
programs,
the
24
23
15
14
13
12
11
10
a
8
7
6
5
4 3
2
0
16’
15
14
13 12.
11’
10’
a
8’
7.
6’
5,
4,
3,
2’
1’
TABLE 6. Mortality quently v Those Rare
in Apnea ly or Never
of Prematurity for Programs Using Theophylline*
Using Theophylline
Fre-Risk Factor/Use of Preterm Total Death Rate/ P Value 95% Confidence Relative
Theophylline Infants Deaths 1,000 Limits Risk
All deaths
Yes 761 4 5.3 0.53 1.4-13.6 0.79
No 748 5 6.7 0.47 5.3-15.6 1.26
Total 1,509 9 6.0 2.7-11.4
SIDS Deaths Only
Yes 761 3 4.0 0.56 0.8-11.7 1.48
No 748 2 2.7 0.54 0.3-9.7 0.68
Total 1,509 5 3.3 1.1-7.7
* Based on the assumption of a Poisson distribution. The P value is the probability of
obtaining the observed number of deaths and its more extreme frequencies based on the
Poisson distribution with an expected number of deaths assuming no difference between the two groups.
mortality ofpremature infants from programs using
theophylline frequently was compared with the
mortality of those from programs that rarely or
never used theophylline. The results are shown in
Table 6. No significant differences were found
be-tween the two groups for total deaths and for SIDS
only.
Among the 1,841 infants who had monitoring
recommended, seven subsequently died of SIDS. Of
these deaths, five were associated with technical errors or noncompliance with monitoring
tech-nique. One infant died of SIDS despite proper
tech-nique and parental response. For one infant, the
record of the monitoring technique at the time of
death was unavailable. There were three other
in-fants who died suddenly in the monitored group;
one died of nonaccidental trauma, one did not have
an autopsy, and one was found to have
subarach-noid hemorrhage at autopsy. There were no
moni-toring errors reported for the latter two infants.
There were seven infants who died among the
1,565 infants who did not have a recommendation
for monitoring at the time of death. Four of these
were deaths due to SIDS, two died of nonaccidental
trauma, and for one no autopsy report was
avail-able. Six of the seven deaths among the
unmoni-tored group were infants with a history of
prema-turity.
DISCUSSION
The findings of this study might have been
af-fected by several factors. This is a retrospective
study, combining reports of different programs that
might have different ways of recording information.
All programs attempted to maintain contact with
patients until the infant was at least 1 year of age.
However, it is likely that there were some infants
lost to follow-up. Therefore, it is possible that some
deaths were unreported. Monitored infants may
have had more close follow-up, and reports may be
more complete for this group. Apnea programs that
have had infant deaths might have responded to
the survey differently. Although every apnea
pro-gram known to us in California was surveyed,
met-ropolitan areas are more heavily represented than
rural areas.
The findings of this study demonstrate that
eval-uation by an infant apnea program does not
elimi-nate the risk of SIDS or death from other causes in
all high-risk infants. Those infants who had
moni-toring recommended were at equal risk of dying of
SIDS as those who did not. However, these results
need not necessarily be interpreted to mean that
home monitoring is ineffective. Infants who had
monitoring recommended are those considered to
be at highest risk for SIDS. Therefore, equivalent
SIDS death rates may be the result of an improved
outlook in the monitored infants.
Previous reports have estimated the risk of dying
of SIDS for infants with unexplained apnea, apnea
of prematurity, and as subsequent siblings of SIDS
victims to be five to ten times that of the general
population.7’5 The average SIDS death rate for the
general population in California was 1.6 per 1,000
live births during 4 of the 5 years of the study (1980 to 1983 inclusive; 1984 statistics were unavailable).
Our results show a SIDS death rate for all of the
infants who had monitoring recommended to be 3.8
per 1,000 infants evaluated. This rate is
signifi-cantly higher than the expected 1.6 per 1,000 death
rate for the general populaton in California at P <
.033 based on the Poisson distribution. Although
this is significantly higher than the risk of the
general population, it is much less than the five to
ten times increased risk previously reported. This
suggests that home monitoring may have prevented
SIDS in some high-risk infants.
Sleep studies such as pneumograms or
polysom-nography are used frequently in the evaluation of
TABLE 7. Sudden Infant Death Syndrome Death Rates and Relative Risk Between
Monitored and Unmonitored Cases After Redefinition of Cases With Technical Errors as
Unmonitored Cases*
Risk Factor Home Moni-toring
Total Infants
SIDS Deaths
SIDS Death Rate/1,000
P
Value
95% Confidence Limits
Relative Risk
1
9
10
0.5
5.7
2.9
0.03 0.04
0.01-3.0 2.6-10.9 1.4-5.4
0.09 11.4 Yes
No
Home monitoring 1,836
without techni- 1,569
cal errors
* Based on the assumption of a Poisson distribution. The P value is the probability of
obtaining the observed number of deaths and its more extreme frequencies based on the
Poisson distribution with an expected number of deaths assuming no difference between the two groups.
shown in our results, sleep studies do not accurately
predict clinical outcome.7’8 Eleven infants who died
of SIDS were studied prior to death. Five of these
infants never had abnormal sleep study findings
prior to death. Because normal sleep study results
do not rule out the possibility of subsequent death
or SIDS, decisions regarding treatment of infants
at increased risk for SIDS should not be made on
the basis of sleep study results alone.
Monitoring errors or noncompliance with
moni-toring technique were commonly reported in
asso-ciation with infant deaths. Seven of the 11 infants
who died of SIDS reported by the apnea programs
had home monitoring recommended at the time of
death. For one infant, the monitoring technique at
the time of death is unknown. For five of the
remaining six infants, there was a technical error
in monitoring at the time of death. If the five
infants whose deaths were associated with a
moni-toring error are considered to have been
unmoni-tored and a new SIDS death rate is calculated, the
difference in SIDS death rate for monitored v
un-monitored becomes significant as shown in Table
7. This is based on the assumption that infants who
were monitored and did not die had no errors in
technique. Also, it is possible that these five infants
would have died despite perfect monitoring
tech-nique. Further studies are needed to settle these
issues; however, at this time it seems prudent to stress compulsive monitoring technique to the
care-takers of infants on home monitors.
Five of the 26 infants who died did so despite
apparently appropriate monitoring technique and
parental response. Two were SIDS deaths, one was
due to a subarachnoid hemorrhage, and, for two, no
autopsy reports are available. These data
demon-strate that home monitoring, even without
appar-ent errors, will not prevent all SIDS deaths.
Oren et al’8 have reported that infants with
re-peat episodes of unexplained sleep apnea requiring
mouth to mouth resuscitation represent an
ex-tremely high-risk group for SIDS (28% SIDS
fatal-ity rate). There were three infants with a similar
history who died of SIDS in our study. Further
evaluation of this extremely high-risk group may
increase our understanding of SIDS and, in time,
decrease the mortality.
Nonaccidental trauma was the cause of death in
four of the 26 deaths reported. Stress within a
family may increase the risk of child abuse. It is
possible that caring for infants at increased risk for
SIDS may increase stress in the family.
Psychoso-cial support for the parents of infants at increased
risk for SIDS should be an integral part of their
care.
ACKNOWLEDGMENTS
This work was supported, in part, by the Los Angeles County, Orange County, and Kern County Chapters of
the Guild for Infant Survival. Dr Davidson Ward is a
recipient of a Research Training Fellowship from the
American Lung Association of California, 1984-86.
The authors thank Bill Burnham of the John Davis
Medical Company, Eileen P. Gates and Susan M.
Book-out of Professional Home Care Services, Mac McIntyre of Mediq Home Therapy Services, and Pauline Sakamoto of the California SIDS Information and Counseling Proj-ect for contributing data to this study; Judy Duncan, MSW, and Wade Rich, CRTT, for assistance with data
collection; and Sharon Edgmon and Kellie Davies for
preparation of the manuscript.
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Pediatrics 1975;55:599-603
$3.2 MILLION SUIT BY
PARENTS
OF SEPTUPLETS
Six months ago, when Samuel and Patricia Frustaci became the parents of
America’s first septuplets, the ebullient father said: “It’s a neat experience.
Family life is great.” But now, with four of the children dead and the survivors
and their mother facing continuing medical problems, the family has sued the
doctor and the clinic who helped make the births possible.
Faced with mounting medical bills, the Frustacis, charging malpractice, are
seeking $3.2 million in damages for the deaths of four of the infants and for
injuries to the three others.
That the three infants survived is a tribute, their doctors say, to neonatal
technology that was unheard of a decade ago. By all accounts there had never
been any survivors in a set of septuplets anywhere in the world.
All three infants are now home with their parents. An alarm is set off if
breathing stops. Then it is usually up to Mrs. Frustaci, who is tied to her infants
through a remote control device attached to the monitors, to shout at the infant
in trouble. Then the infant remembers to breathe.
The infants also have heart and eye problems. One has a hernia. Another can
be fed only while lying on his stomach. Mrs. Frustaci says she now suffers from
a kidney disorder, among other problems.
Mr. Frustaci’s insurance covers each of the children for up to $1 million for
life, but the infants’ problems are expected to continue, and their medical bills
may soon reach $2 million.
