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Published on: August 25, 2014
Isolated mental developmental delay in very low birth weight infants: association with prolonged doxapram therapy for
C Sreenan1, P C Etches, N Demianczuk
1Neonatal Intensive Care Unit and Department of Perinatology, Royal Alexandra Hospital, Edmonton, Alberta, Canada.
Insights
High-dose or long-term doxapram therapy for apnea of prematurity in very low birth weight infants is linked to isolated mental delay. Further research is needed on potential adverse effects.
Area of Science:
- Neonatology
- Developmental Pediatrics
- Pharmacology
Background:
- Infants weighing less than 1250g are at risk for neurodevelopmental issues.
- Apnea of prematurity is common in very low birth weight infants.
- Doxapram is used to treat apnea of prematurity.
Purpose of the Study:
- To identify factors associated with isolated mental delay in very low birth weight infants.
- To investigate the role of doxapram therapy in neurodevelopmental outcomes.
Main Methods:
- A case-control study design was employed.
- 40 cases with mental developmental index < 70 were matched with controls (index > or = 85) at 18 months corrected age.
- Matching variables included gestation, birth weight, sex, intraventricular hemorrhage grade, and socioeconomic status.
Main Results:
- No significant differences were found in neonatal complications or steroid use between groups.
- Infants with mental delay received significantly higher cumulative dosages and longer durations of doxapram therapy for apnea of prematurity.
- Multivariate analysis did not reveal additional predictive variables.
Conclusions:
- The total dosage and duration of doxapram therapy for severe apnea of prematurity are associated with isolated mental delay in very low birth weight infants.
- Doxapram may serve as a marker for cerebral dysfunction.
- Potential adverse effects of doxapram or its preservative, benzyl alcohol, on the developing brain warrant further investigation.
Objective:
We investigated factors associated with isolated mental delay in infants weighing < 1250 g at birth.
Study Design:
With a case-control design, matching variables for 40 cases included gestation, birth weight, sex, grade of intraventricular hemorrhage, and socioeconomic status. Case subjects had a mental developmental index < 70, and controls had a mental developmental index > or = 85, according to the Bayley Scales of Infant Development II at 18 months' corrected age.
Results:
There were no differences between the case and control subjects for neonatal complications and antenatal or postnatal steroid use. There was a marked difference in the cumulative dosage and duration of doxapram therapy used for apnea of prematurity (total dose 2233 +/- 1927 mg vs 615 +/- 767 mg, P < .001; duration 45.2 +/- 32.5 days vs 19.4 +/- 23.4 days, P < .001 for case subjects and control subjects, respectively). Multivariate analysis did not identify additive predictive variables.
Conclusion:
Isolated mental delay in infants weighing < 1250 g at birth was associated with the total dosage and duration of doxapram therapy for severe apnea. Although this may be a marker for cerebral dysfunction manifesting as apnea of prematurity, possible adverse effects of doxapram or its preservative, benzyl alcohol, on the developing brain deserve further study.
