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Management of Apnoea in Extremely Preterm Infants: A European Survey
Anna Lavizzari1, G Jeroen Hutten2,3, Christian Heiring4
1Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
Insights
Apnoea management in extremely preterm infants varies across Europe, despite consistent caffeine dosing. Further research is needed to optimize respiratory support strategies and stimulant use for these vulnerable infants.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Clinical Pharmacy
Background:
- Apnoea is a common challenge in extremely preterm infants (EPIs), necessitating effective management strategies.
- Current treatment involves caffeine and respiratory support, but variations in definitions, monitoring, and stimulant use exist.
- Understanding these practice differences is crucial for advancing apnoea treatment in EPIs.
Purpose of the Study:
- To investigate current European neonatal intensive care unit (NICU) practices for monitoring and treating apnoea in EPIs.
- To identify variations in the use of caffeine, doxapram, and non-invasive respiratory support.
- To inform future research and clinical guidelines for apnoea management.
Main Methods:
- A web-based survey was distributed to lead consultants in European tertiary NICUs between March and July 2024.
- The survey collected data on apnoea definitions, monitoring techniques (ECG, pulse oximetry), and treatments (caffeine, doxapram, non-invasive ventilation).
- Data were analyzed from 447 NICUs across 24 European countries.
Main Results:
- Caffeine citrate is universally used, with 23% initiating it in the delivery room; dosing and weaning protocols show consistency.
- Doxapram use varies geographically (25% of NICUs).
- Non-invasive respiratory support strategies and automatic closed-loop oxygen delivery (used in 25% of NICUs) lack standardized protocols.
Conclusions:
- Significant heterogeneity exists in European apnoea management for preterm infants, particularly concerning non-invasive support.
- Standardization of apnoea definitions and monitoring practices is needed.
- Future research should prioritize optimal caffeine timing/dosage, doxapram efficacy, and non-invasive respiratory support optimization.
Introduction:
Episodes of apnoea are common in extremely preterm infants (EPIs) and usually treated with caffeine and respiratory support. Understanding differences in apnoea definitions, monitoring practices, and use of respiratory stimulants is essential to improve future treatment.
Methods:
Between March and July 2024, one lead consultant at European tertiary neonatal intensive care units (NICUs) was invited to complete a web-based survey on respiratory practices in EPIs. We sought information how they defined apnoea and monitored for it, and how they treated it with caffeine, doxapram, and non-invasive respiratory support.
Results:
We received replies from 447/721 (62%) NICUs across 24 European countries. Most NICUs (74%) use both electrocardiogram electrodes and pulse oximetry for apnoea monitoring. All NICUs reported using caffeine citrate, with 102 centres (23%) starting it in the delivery room. The median loading, maintenance and maximum maintenance doses used are 20 mg/kg, 5 and 10 mg/kg/day, respectively. Caffeine is occasionally given twice daily in some NICUs (30%) and stopped at 34-35 weeks of postmenstrual age at most of them (74%). Doxapram is used at 111 (25%) NICUs, with geographical differences. Strategies for the use and escalation of non-invasive respiratory support in case of persistent apnoea are not clearly defined. Automatic closed-loop oxygen delivery is used at 25% of NICUs.
Conclusion:
Despite consistency in the dosing and weaning of caffeine, there is much variation in the management of apnoea in preterm infants across Europe. Future research should focus on timing and dosage of caffeine, the use of doxapram, and strategies for optimising non-invasive respiratory support.
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