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Risks and benefits of therapies for apnoea in premature infants
J M Hascoet1, I Hamon, M J Boutroy
1Medecine et Reanimation Neonatales, Maternite Regionale Universitaire, Nancy, France. jm.hascoet@maternite.chu-nancy.fr
Insights
Infant apnoea requires careful evaluation and monitoring. Methylxanthines like caffeine are recommended first-line treatments for idiopathic apnoea in premature infants.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Clinical Pharmacology
Background:
- Infant apnoea presents diverse etiologies necessitating thorough assessment.
- Continuous monitoring is crucial for understanding pathophysiology and apnoea type in premature infants.
- Treatment decisions require evaluating the cause, efficacy, and tolerability of interventions.
Purpose of the Study:
- To outline the management strategies for infant apnoea.
- To define the objectives of apnoea treatment, focusing on preventing adverse outcomes.
- To review pharmacological and non-pharmacological treatment options.
Main Methods:
- Continuous monitoring of premature infants with apnoea.
- Assessment of aetiology, efficacy, and tolerability for individualized treatment selection.
- Review of evidence for methylxanthines (caffeine, theophylline), doxapram, and nasal continuous positive airway pressure (nCPAP).
Main Results:
- Methylxanthines, particularly caffeine, are suggested as first-line therapy for idiopathic apnoea due to efficacy and tolerability.
- Caffeine shows particular efficacy against the central component of idiopathic apnoea of prematurity.
- Alternative treatments like doxapram or nCPAP are considered if initial therapy fails or based on specific apnoea types.
Conclusions:
- Effective management of infant apnoea involves a stepwise approach, starting with methylxanthines.
- Prenatal betamethasone is advocated for apnoea prophylaxis.
- Treatment weaning and post-weaning monitoring are critical to prevent relapse.
Abstract:
Apnoea in infants can result from a wide range of causes, and requires thorough evaluation before deciding on appropriate treatment. Continuous monitoring of premature infants with apnoea is mandatory in order to define the pathophysiology and type of apnoea; selection of treatment involves careful assessment of aetiology, as well as efficacy and tolerability in each individual case. The objective of treatment is to prevent the deleterious consequences of apnoeas that last >20 seconds and/or are associated with bradycardia, cyanosis or pallor, and occur more often than once an hour over a 12-hour period. Apnoea management involves both pharmacological and nonpharmacological treatment. We suggest methylxanthines as first-line therapy for idiopathic apnoeas; evidence suggests that caffeine is better tolerated and as efficacious as theophylline (since it is particularly efficacious against the 'central' component of idiopathic apnoea of prematurity). If treatment fails, additional measures such as doxapram may be appropriate when hypoventilation is present, or nasal continuous positive airway pressure when upper airway instability or obstructive apnoeas are predominant. Apnoea prophylaxis is an additional reason to advocate prenatal maturation with betamethasone. Weaning from treatment is attempted 4 to 5 days after complete resolution of apnoea, beginning with the last treatment introduced. Monitoring should be maintained for 4 to 5 days to detect any relapse of recurrent and severe apnoeas, which would lead to the resumption of the most recently withdrawn treatment.