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Prophylactic theophylline infusion for prevention of apnea of prematurity
R H Merchant1, V S Sakhalkar, T F Ashavaid
1Division of Neonatology, B.J. Wadia Hospital for Children, Nanavati Hospital, Bombay.
Insights
Prophylactic theophylline infusion significantly reduced primary apnea in preterm infants. This treatment demonstrated a clear advantage in preventing apnea, with fewer events observed in the treated group compared to the control group.
Area of Science:
- Neonatal Medicine
- Pharmacology
Background:
- Apnea of prematurity is a common challenge in neonatal care.
- Theophylline is a methylxanthine drug with respiratory stimulant properties.
Purpose of the Study:
- To evaluate the efficacy of prophylactic theophylline infusion in preventing primary apnea in preterm infants.
Main Methods:
- A comparative study involving 56 preterm infants (< 34 weeks gestation) receiving theophylline infusion (Group A) and 25 matched controls (Group B).
- Theophylline (aminophylline) was infused at rates of 0.2-0.38 mg/kg/h.
- Serum theophylline levels were monitored using Fluorescence Polarization Immunoassay.
Main Results:
- Group A had significantly fewer cases of primary apnea (1/48) compared to Group B (4-21), with p < 0.05.
- Serum theophylline levels ranged from 2.3 to 39.5 µg/ml (mean 12.7 µg/ml).
- A statistically significant correlation was found between birth weight and serum theophylline levels (r = 0.45).
Conclusions:
- Prophylactic theophylline infusion is effective in preventing primary apnea in preterm infants.
- Therapeutic drug monitoring is crucial to manage serum theophylline levels and avoid toxicity.
Abstract:
To assess if there was any advantage in the prophylactic use of theophylline to prevent apnea in preterms, we treated 56 preterms (Group A) < 34 weeks gestation with theophylline infusion and compared these with 25 age and weight matched preterms (Group B) who received no therapy. Aminophylline (25 mg/ml) was infused from admission in all neonates (group A) at rates ranging 0.2 to 0.38 mg/kg/h and blood levels estimated on an Abbots TDX analyser by Fluorescence Polarization Immunoassay, after 5 days infusion. All neonates (Groups A + B) were monitored on a Corometric 505 neonatal monitor. In Group A, 1/48 developed primary apnea while in Group B, 4-21 had primary apnea (p < 0.05). Serum theophylline ranged from 2.3 to 39.5 micrograms/ml with a mean of 12.7 micrograms/ml. The mean serum level of theophylline in 4 cases who exhibited clinical evidences of toxicity was 30.1 micrograms/ml. A statistically significant difference (p < 0.05) was noted in birth weight and serum level inspite of similar infusion rates of theophylline. A linear correlation r = 0.65 was noted between serum level and infusion rate. Multivariate regression analysis, between birth weight and gestational age to serum level, showed a linear correlationship only between birth weight and serum level (r = 0.45).