Methylxanthine for apnea of prematurity

Abstract

Over the years, multiple interventions have been used to treat apnea of prematurity – ranging from increased oxygen exposures to physical stimulation to pharmacologic interventions. The group in Winnipeg have a distinguished record of studies of respiratory control in infants. Recently, they have explored the potential of increased CO2 as a stimulant of respiratory drive. They now report a well-designed randomized and controlled trial of increased inspired CO2 in comparison to theophylline treatments for infants with apnea of prematurity. Both treatments worked, but theophylline was clearly a superior treatment. Given that the trial by Schmidt et al of caffeine demonstrated not only safety, but improved neurodevelopmental outcomes (NEJM 2007;357:1893-1902), and giving a drug is easier than providing a gas containing CO2 to infants, the practical conclusion from this trial is that methylxanthine therapy is the standard of care for infants with enough apnea of prematurity to need treatment. However, the concept that increasing CO2 will increase respiratory drive is physiologically sound and should not be forgotten. Article page 252▶ CO2 Inhalation as a Treatment for Apnea of Prematurity: A Randomized Double-Blind Controlled TrialThe Journal of PediatricsVol. 160Issue 2PreviewTo compare the effect of prolonged inhalation of a low concentration of CO2 with theophylline for the treatment of apnea of prematurity. Full-Text PDF