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Published on: June 21, 2024
Amplitude-integrated electroencephalography shows that doxapram influences the brain activity of preterm infants
Christine Czaba-Hnizdo1, Monika Olischar, Zsofia Rona
1Division of Neonatology, Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.
Insights
Doxapram treatment in preterm infants affects brain activity, increasing seizure risk and reducing sleep-wake cycles. Use doxapram cautiously in very preterm infants based on amplitude-integrated electroencephalography (aEEG) findings.
Area of Science:
- Neonatal Neurology
- Neurophysiology
- Developmental Pediatrics
Background:
- Preterm infants often experience apnea, a breathing cessation.
- Caffeine citrate and doxapram are used to manage apnea in preterm infants.
- Amplitude-integrated electroencephalography (aEEG) monitors cerebral function.
Purpose of the Study:
- To evaluate the impact of doxapram on brain activity in preterm infants.
- To identify potential adverse effects of doxapram on cerebral function using aEEG.
- To compare aEEG findings in infants treated with doxapram versus controls.
Main Methods:
- Analysis of aEEG tracings in 13 preterm infants (<30 weeks gestation) before, during, and after doxapram treatment.
- Assessment of background brain activity patterns (continuous vs. discontinuous).
- Evaluation of sleep-wake cycling and electrographic seizure activity, compared to 61 controls.
Main Results:
- Doxapram treatment correlated with increased continuous background activity (19% to 38%) and decreased discontinuous patterns.
- Electrographic seizure activity increased significantly (0% to 15%) during doxapram administration.
- Sleep-wake cycling decreased (92% to 85%) with doxapram treatment, confirmed by control group comparison.
Conclusions:
- Doxapram significantly alters aEEG patterns in preterm infants.
- Observed changes include increased continuous activity, more seizures, and reduced sleep-wake cycling.
- Caution is advised when using doxapram in very preterm infants due to these cerebral effects.
Aim:
The aim of this study was to measure the brain activity of preterm infants treated with caffeine citrate and doxapram for preterm apnoea, using amplitude-integrated electroencephalography (aEEG), to identify any adverse effects on cerebral function.
Methods:
We analysed the aEEG tracings of 13 preterm infants <30 weeks of gestation before, during and after doxapram treatment, with regard to background activity (percentages of continuous and discontinuous patterns), occurrence of sleep-wake cycling and appearance of electrographic seizure activity. They were also compared with 61 controls without doxapram treatment.
Results:
During doxapram treatment, aEEG tracings showed an increase in continuous background activity (19 ± 30% before treatment, 38 ± 35% during treatment) and a decrease in discontinuous patterns. In addition, they showed more frequent electrographic seizure activity (0% before treatment, 15 ± 37% during treatment) and less frequent sleep-wake cycling (92 ± 27% before treatment, 85 ± 37% during treatment) could be observed. These results were confirmed when compared to the control group.
Conclusion:
Doxapram treatment influences aEEG in preterm infants, showing higher percentages of continuous activity as well as more electrographic seizure activity and less sleep-wake cycling. It should, therefore, be used with caution in very preterm infants.
