INDICES> apnea of premature (2)

["marceg@ull.es" <marceg@ull.es>]

INDICES> apnea of premature (2)
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Dear sir,

We may use caffeine, aminophylline or theophylline as adjunt treatment,
in addition to administration of oxygen (increased environmental oxygen
or artificial ventilation), sensory stimulation (cutaneous, vestibular,
or proprioceptive) or low pressure nasal continuous positive airway
pressure (CPAP); and no in all prematures after some hours... only in
the treatment of idiopathic apnea in neonates, characterized by
cessation of respiration that lasts 20 seconds or longer (USP), other
authors say 10 to 15 seconds. Apnea of premature is characterized by
periodic breathing and apneic episodes of more than 15 seconds
accompanied of cyanosis and bradycardia (90%).

- Usually, its incidence is age inversely proportional. Nelson (Textbook
of pediatric) says that in premature is unfrequently during his first
day, an apnea early after deliver indicate another basic alteration. The
idiopathic apnea begins 2nd to 7th day, and you may watch over any
premature with low weigth (< 2 kg).

- Loading dose of aminophylline or theophylline 5 mg/kg as a single dose
(oral or iv) or caffeine 20 mg/kg (oral); and

- Maintenance with oral solution (or i.v.): amynoph. or theoph. 1-2
mg/kg/12 hs or caffeine 5 mg/kg/day

- If you can monitoring level of drugs... may be at third day of
treatment and each week (if you change doses, you'll begin meassure:
first at third day). Therapeutic levels: theophylline or aminophylline
5-15 microgr/mL, caffeine 5-25 microgr/mL.

- Drug treatment is usually required for only a few weeks: the apnea
usually resolves by about 34 to 36 weeks' gestational age; and usually
its diagnostic does not modify the neonatal pronostic.

Marcelino Garcia
MD, PhD
Drug Surveillance and Therapeutic Information Centre
Canary Islands
Spain

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