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Neonatal apnea, xanthines, and necrotizing enterocolitis.

J L Grosfeld, M C Dalsing, M Hull

    Journal of Pediatric Surgery
    |February 1, 1983
    PubMed
    Summary

    Aminophylline (AMPH) treatment for premature apnea may worsen outcomes in neonatal necrotizing enterocolitis (NEC) models. This study found AMPH increased bowel injury and mortality in infant rats subjected to bowel ischemia, questioning its use in at-risk neonates.

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    Area of Science:

    • Neonatal physiology
    • Gastrointestinal research
    • Pharmacology

    Background:

    • Premature apnea is a common concern in neonates.
    • Necrotizing enterocolitis (NEC) is a serious gastrointestinal condition in premature infants.
    • Xanthine derivatives like aminophylline (AMPH) are sometimes used to treat apnea.

    Purpose of the Study:

    • To investigate the effect of aminophylline (AMPH) on bowel injury and mortality in a neonatal rat model of bowel ischemia.
    • To evaluate the relationship between xanthine treatment and necrotizing enterocolitis (NEC) development.

    Main Methods:

    • A bowel ischemia model was created in 82 weanling rats by occluding the superior mesenteric artery.
    • Group I (n=41) served as untreated controls.
    • Group II (n=21) received aminophylline (AMPH) intraperitoneally before ischemia.

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  • Bowel infarction, perforation, and mortality were assessed at 7 days.
  • Scanning electron microscopy (EM) evaluated mucosal damage and bacterial overgrowth in a subset of rats.

    • Main Results:

    • Bowel ischemia occurred in 60% of controls and 90% of AMPH-treated rats.
    • Necrosis and perforations were observed in both groups, with higher rates in the AMPH group.
    • Mortality was significantly higher in the AMPH group (90%) compared to controls (60%) (p < .05).
    • EM showed enhanced bacterial overgrowth with AMPH, but similar mucosal damage.

    Conclusions:

    • Aminophylline (AMPH) administration appears to have an adverse effect on the bowel following ischemia in this neonatal model.
    • The findings raise concerns about the safety and efficacy of using AMPH in premature infants at risk for necrotizing enterocolitis (NEC).
    • Further research is needed to clarify the role of xanthines in neonatal gastrointestinal conditions.