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Percutaneous administration of theophylline in the preterm infant
Insights
Percutaneous theophylline administration is a viable option for preterm infants, leveraging their permeable skin. This method effectively achieved therapeutic drug levels, offering a new delivery route for neonatal care.
Area of Science:
- Neonatal Medicine
- Pharmacology
- Dermatology
Background:
- Preterm infant skin offers limited protection against chemical absorption.
- Theophylline is a critical medication for treating neonatal respiratory issues.
Purpose of the Study:
- To evaluate the efficacy and feasibility of percutaneous theophylline administration in preterm infants.
- To determine if theophylline gel applied topically can achieve therapeutic blood levels.
Main Methods:
- Theophylline gel (17 mg anhydrous) applied to a 2 cm diameter area on the upper abdomen under occlusion.
- Serial blood theophylline levels were measured in preterm infants (≤30 weeks gestation).
- Studies included infants with and without prior intravenous aminophylline treatment.
Main Results:
- Therapeutic theophylline levels (>4 mg/L) achieved in 11/13 infants without prior treatment, maintained up to 72 hours.
- Sustained theophylline levels for up to 70 hours in infants previously on intravenous aminophylline.
- Absorption decreased with increased postnatal age, but satisfactory levels were reached up to 20 days of age.
Conclusions:
- Percutaneous theophylline administration is a feasible and effective method for preterm infants.
- This route offers an alternative for maintaining therapeutic theophylline levels in neonates.
- Further research may optimize this delivery method for neonatal respiratory support.
Abstract:
The preterm infant's skin is a poor barrier to the absorption of chemical agents. The possibility of turning this to the infant's advantage was explored by using the percutaneous route to administer theophylline. A standard dose of theophylline gel, equivalent to 17 mg anhydrous theophylline, was applied to an area of skin 2 cm in diameter over the upper abdomen under an occlusive dressing, and serial theophylline levels were measured; 25 studies were performed in 20 infants of less than or equal to 30 weeks gestation. Therapeutic theophylline levels (greater than 4 mg/L) were achieved in 11 of 13 infants who had not previously received the drug, and were maintained for up to 72 hours. In 12 studies in infants who were previously receiving aminophylline intravenously, theophylline levels were maintained for up to 70 hours. There was a significant decline in the amount of theophylline absorbed in the first 24 hours after application as the infant's postnatal age increased, but satisfactory blood levels were achieved in infants up to 20 days of age. The percutaneous route is a feasible method of administering theophylline in preterm infants.