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The use of primidone in neonates with theophylline-resistant apnea
C A Miller1, M Gaylord, V Lorch
1Department of Pediatrics, University of Tennessee School of Medicine, Knoxville 37920.
Insights
Primidone significantly reduced apnea and bradycardia in premature infants resistant to theophylline. This suggests primidone as a potential adjunctive treatment for apnea of prematurity.
Area of Science:
- Neonatal Medicine
- Pharmacology
Background:
- Apnea of prematurity is a common concern in neonatal intensive care.
- Theophylline is a standard treatment, but some infants show resistance.
Purpose of the Study:
- To evaluate primidone's efficacy in neonates with theophylline-resistant apnea of prematurity.
Main Methods:
- Retrospective review of 16 premature infants with recurrent apnea and bradycardia despite theophylline.
- Primidone was administered at 10-15 mg/kg/day.
Main Results:
- A significant decrease in apnea (68%) and bradycardia (69%) was observed within 24-72 hours of primidone initiation.
- No toxic reactions were reported during the study period.
Conclusions:
- Primidone may serve as an effective adjuvant therapy for theophylline-resistant apnea of prematurity.
- Further controlled prospective studies are recommended due to primidone's complex pharmacology.
Objective:
To determine whether primidone reduced the occurrence of apnea of prematurity in neonates with apnea resistant to theophylline.
Design:
Retrospective review.
Setting:
Neonatal intensive care unit.
Participants:
Sixteen premature infants (mean age, 27.8 weeks) in whom apnea and bradycardia recurred despite therapeutic levels of theophylline. Six of the patients were receiving assisted ventilation.
Intervention:
Administration of primidone (10 to 15 mg/kg per day) orally or by nasogastric tube at a mean age of 35 days.
Results:
Apnea and bradycardia decreased significantly 24 to 72 hours after initiation of primidone treatment (by 68% and 69%, respectively) compared with pretreatment events. We obtained similar results after a separate analysis of the 10 patients who had been weaned from assisted ventilation before treatment with primidone. No toxic reactions were observed.
Conclusions:
Primidone represents a possible adjuvant therapy in theophylline-resistant apnea of prematurity. Caution is advised, because of primidone's complex pharmacologic characteristics, until there are further controlled prospective studies.