MANAGEMENT OF APNOEA OF PREMATURITY

Abstract

Neonatal apnoea remains a frustrating problem in neonatal intensive care and frequently prolongs the hospitalisation of preterm infants. As a result, a variety of therapeutic strategies has been employed in this high-risk population. These can be characterised as accepted interventions that are relatively well studied and therapeutic approaches that need further characterisation. The mainstay of treatment for these infants is continuous positive airway pressure (CPAP) delivered via a variety of techniques and xanthine therapy. CPAP is effective via both splinting of the upper airway and maintenance of functional residual capacity. Xanthine therapy has been shown to be both effective and beneficial in decreasing postnatal morbidity. The mechanism by which this longer term benefit occurs is still under study. Therapeutic approaches that clearly need further study include pharmacological management of gastroesophageal reflux, which remains controversial. Other new approaches include the administration of a low inspired carbon dioxide and various behavioural interventions, such as kangaroo care and other environmental stimuli. Baseline levels of oxygen saturation are also being studied and would be expected to influence apnoea rates. Meanwhile, the long-term consequences of apnoea of prematurity on both cardiorespiratory control and neurodevelopmental outcome need clarification as this will determine the intensity with which therapeutic approaches would be employed.