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Pharmacologic manipulation of the respiratory control center in the infant
1Department of Pediatrics, University of Medicine and Dentistry of New Jersey, School of Osteopathic Medicine, Stratford.
Insights
Pharmacologic agents can help manage infant respiratory control issues. Theophylline is effective for bronchopulmonary dysplasia and apnea, while other drugs show limited or experimental success in infant respiratory support.
Area of Science:
- Neonatal Medicine
- Respiratory Physiology
- Pharmacology
Background:
- Infant respiratory control relies on afferent stimuli and central nervous system (CNS) control.
- Dysfunction in these systems leads to significant infant morbidity and mortality.
- Pharmacologic interventions are being explored to support infant respiratory function.
Purpose of the Study:
- To review the current understanding of respiratory control in infants.
- To evaluate the efficacy of various pharmacologic agents in managing infant respiratory insufficiency.
- To identify potential therapeutic strategies for neonatal respiratory disorders.
Main Methods:
- Literature review of studies on respiratory control mechanisms in infants.
- Analysis of clinical trial data and case reports on pharmacologic interventions.
- Evaluation of drug efficacy and safety profiles for neonatal respiratory support.
Main Results:
- Theophylline demonstrates efficacy in treating bronchopulmonary dysplasia and apnea in infants.
- Naloxone is ineffective for asphyxiated infants.
- Doxapram shows potential for refractory apnea and hypoventilation syndromes.
- Almitrine has not proven effective in infants.
- Progesterone and prostaglandin are experimental.
Conclusions:
- Pharmacologic manipulation offers a potential avenue for treating infant respiratory control deficiencies.
- Theophylline is a clinically validated option for specific neonatal respiratory conditions.
- Further research is needed for agents like doxapram, progesterone, and prostaglandin.
Abstract:
The respiratory control center receives afferent stimuli from mechanical and neuromechanical sources. Information from both these sources, combined with voluntary and involuntary CNS control, effects stimulation of the respiratory muscles. In the infant, insufficiency of one or more of these elements of the respiratory control center is associated with considerable morbidity and mortality. Pharmacologic manipulation may provide a means of intervention. The xanthine derivative theophylline has been successfully used in the treatment of bronchopulmonary dysplasia and apnea in the infant. Naloxone, an endorphin antagonist, is widely used for the reversal of narcotic-induced respiratory depression but has not been shown to be clinically effective for either severely or moderately asphyxiated infants. Although doxapram has not been extensively studied and lacks an oral preparation, it is a potentially viable therapy in the treatment of refractory apnea and congenital hypoventilation syndromes. Almitrine's success in adults with chronic obstructive pulmonary disease has not been duplicated in infants with similar respiratory impairments. Progesterone and prostaglandin, although proved to influence respiratory activity, should be regarded as very experimental therapeutic modalities.