1554 efficacy of theophylline for prevention of post-extubation respiratory failure in INFANTS LESS THAN 1250 GRAMS

Abstract

Because methylxanthines modulate apnea and enhance intercostal and diaphragmatic contractility, we hypothesized that administration of theophylline to infants < 1250 gm on low ventilatory settings would facilitate extubation and prevent post-extubation respiratory failure. A prospective, randomized, blinded, placebo-controlled trial was performed. Twenty-five infants [11 placebo (P), 14 treated (T)] who were < 1250 grams on assisted ventilation with FiO2 ≤ .30, PIP ≤ 20, IMV ≤ 10 were enrolled. Electrolyte abnormalities and anemia were corrected before entry and absence or stability of IVH was confirmed by cranial sonography. Prior to extubation, T infants received 6 mg/kg theophylline loading dose IV or PO and then a maintenance dose 2 mg/kg q 12h for 5 doses. Control infants received equal volumes of normal saline. No significant differences existed between groups for birthweight, GA, duration of ventilation, and peak FiO2. Nine of 14 T infants and only 1 of 11 P infants were successfully extubated for at least 5 days (p=0.01). Of 5 T infant failures, 2 had congestive heart failure with patent ductus arteriosus and 3 had severe apnea. Of 10 P infant failures, 8 had recurrent apnea and 2 failed to wean from the respirator during the study period. Seven of 9 P infants were later successfully extubated with theophylline. We conclude that theophylline therapy prior to extubation of infants < 1250 gms is effective in preventing post-extubation respiratory failure.