Treating Apnea of Prematurity.

Joseph Pergolizzi,Peter Magnusson,Robert Raffa,Alexander Kraus,Jo Ann K Lequang,Kailyn Mitchell,Giustino Varrassi,Frank Breve

doi:10.7759/cureus.21783

Abstract

Premature babies often suffer apnea of prematurity as a physiological consequence of an immature respiratory system. Hypercapnia may develop, and neonates with apnea of prematurity are at an increased risk of morbidity and mortality. The long-term effects of apnea of prematurity or their treatments are less clear. While a number of treatment options exist for apnea of prematurity, there is no clear-cut “first-line” approach or gold standard of care. Effective treatments, such as caffeine citrate, carbon dioxide inhalation, nasal continuous positive airway pressure, nasal intermittent positive pressure ventilation, and others, may be associated with safety concerns. More conservative treatments are available, such as kangaroo care, postural changes, and sensory stimulation, but they may not be effective. While apnea of prematurity resolves spontaneously as the respiratory system matures, it can complicate neonatal care and may have both short-term and long-term consequences. The role, if any, that apnea of prematurity may play in mortality of preterm neonates is not clear.

Highlights

BackgroundApproximately 11% of births globally are preterm, which s defined as birth before 37 gestational weeks [1].Premature birth does not accelerate respiratory development, meaning that these neonates must rely on fetal pulmonary mechanisms, which often leads to a form of respiratory instability known as apnea of prematurity (AOP)
In a randomized double-blind study of 85 preterm infants with AOP for whom neither caffeine nor continuous positive airway pressure (CPAP) was effective, neonates were treated with doxapram and followed for four days
In a study of 11 preterm infants randomized to intravenous doxapram or placebo, the doxapram group had fewer treatment failures within 48 hours, but this study only evaluated short-term responses [52]

Summary

Introduction

11% of births globally are preterm, which s defined as birth before 37 gestational weeks [1]. In a randomized double-blind study of 85 preterm infants with AOP for whom neither caffeine nor CPAP was effective, neonates were treated with doxapram and followed for four days. In a study of 19 preterm infants with AOP (mean gestational age of 30 weeks), neonates received flow-synchronized NIPPV, conventional NIPPV, or NCPAP for four-hour treatment sessions and were crossed over [72]. A meta-analysis of five clinical trials (n=108 total) comparing theophylline to caffeine for treating AOP in preterm infants found no differences between groups in terms of early treatment failure (one to three days), or later treatment failure (five to seven days) or the rate of apnea, but the caffeine groups had fewer adverse events [85]. There is an unmet need for a treatment that is both effective and safe for this particular special population

Conclusions

Findings

Disclosures