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Management of apnea in infants
1College of Pharmacy, University of Arizona, Tucson 85721.
Insights
Methylxanthines like theophylline and caffeine are key treatments for apnea of prematurity and infancy. These drugs help manage breathing issues in infants, though caffeine availability is limited.
Area of Science:
- Neonatal Medicine
- Pharmacology
Background:
- Apnea of infancy and prematurity stem from immature neurological development or secondary conditions.
- Respiratory control defects during sleep are a proposed mechanism for infant apnea.
Purpose of the Study:
- To review the incidence and proposed mechanisms of apnea in infants.
- To discuss the use of methylxanthines for managing apnea of prematurity and infancy.
Main Methods:
- Literature review of apnea mechanisms and methylxanthine pharmacology.
- Discussion of therapeutic approaches and drug metabolism in neonates.
Main Results:
- Methylxanthines, specifically theophylline and caffeine, are primary pharmacologic treatments.
- Drug metabolism and half-life in infants differ significantly from adults, with prolonged effects.
Conclusions:
- Theophylline and caffeine are accepted treatments for apnea of prematurity.
- Theophylline is used for apnea of infancy, but with less documented efficacy compared to prematurity.
- Caffeine shows potential advantages but lacks a suitable product for use.
Abstract:
The incidence and proposed mechanisms of apnea of infancy and apnea of prematurity are briefly reviewed, and the use of methylxanthines in managing these conditions is discussed. Apnea may result from incomplete neurological development of the infant. A sleep-related defect in respiratory control mechanisms has been proposed. Apnea may be secondary to physiologic abnormalities that cause airway obstruction or to cardiac disease or arrhythmia, seizure disorders, infection, or other disorders. Therapy often includes supportive management. The primary pharmacologic agents used to treat apnea of prematurity are caffeine and theophylline. The metabolism of these drugs differs greatly between newborns and adults and changes rapidly in the first nine months of life; in infants up to 4 1/2 months of age, the half-life of these compounds is prolonged. While only theophylline is approved in the United States for management of apnea, caffeine has several potential advantages. However, no suitable caffeine product is available. The accepted pharmacologic treatment for apnea of prematurity is the use of the methylxanthines theophylline and caffeine. Theophylline has also been used in treating apnea of infancy, although there are fewer data documenting its efficacy for this indication.