Brain Hemodynamic Changes in Preterm Infants after Maintenance Dose Caffeine and Aminophylline Treatment

Dani, Carlo; Bertini, Giovanna; Reali, Maria Francesca; Tronchin, Michele; Wiechmann, Lisa; Martelli, Elena; Rubaltelli, F F

doi:10.1159/000014243

Cited by 51 publications

(25 citation statements)

References 22 publications

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“…Recent studies confirmed the validity of mixed cerebral oxygen saturation, measured by near infra-red spectroscopy, in monitoring brain oxygenation 22,23 and fixed 62% -75% as normal values in adults 24 and 40% as a normal value in fetuses 25 . Our data show that cerebral mixed cerebral oxygen saturation in healthy term infants is similar to those of preterm infants 26 and adults 24 . Finally, we reported the relative changes of oxidizedreduced cytochrome aa3.…”

Section: Discussionsupporting

confidence: 60%

Haemodynamic changes in the brain after vaginal delivery and caesarean section in healthy term infants

Dani¹

2002

BJOG: An International Journal of Obstetrics and Gynaecology

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Objective To investigate whether the mode of delivery may affect neonatal cerebral haemodynamics during the first hour of life. Design Prospective study.Sample Healthy infants with gestational age ! 37 weeks and birthweight appropriate for gestational age, born after uncomplicated pregnancy by vaginal delivery or elective caesarean section, two to five hours after the delivery. Methods Near infra-red spectroscopy was used to measure changes of oxygenated haemoglobin, deoxygenated haemoglobin, oxidized-reduced cytochrome aa3, and mean cerebral oxygen saturation (mixed cerebral oxygen saturation ¼ oxygenated haemoglobin/total haemoglobin). Changes in cerebral blood volume were calculated. Results Near infra-red spectroscopy data did not show significant differences between infants born by vaginal delivery or by caesarean section. There was a significant decrease of oxygenated haemoglobin and change of cerebral blood volume values at 120 and 180 minutes in both the groups, while deoxygenated haemoglobin and oxidized-reduced cytochrome aa3 were unchanged. Conclusions A decrease of cerebral blood volume occurs after birth and this occurs both in infants born by vaginal delivery and by caesarean section.

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Section: Discussionsupporting

confidence: 60%

Haemodynamic changes in the brain after vaginal delivery and caesarean section in healthy term infants

Dani¹

2002

BJOG: An International Journal of Obstetrics and Gynaecology

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“…[68] Controversy exists as to the effect of methylxanthines on CBF. According to a recent study, [69] caffeine does not affect cerebral hemodynamics to any great extent. Low doses of aminophylline increase cerebral blood volume and oxygenated hemoglobin transiently.…”

Section: Circulatory Endocrine and Metabolic Effects Of Methylxanthimentioning

confidence: 92%

Treatment of Apnea of Prematurity

Bhatt‐Mehta

Schumacher

2003

Pediatric Drugs

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In the last decade, knowledge regarding the neurodevelopment and functional aspects of the respiratory centers during postnatal maturation has increased substantially. However, an increase in such knowledge has not provided a basis for change in practice. The diagnosis of apnea of prematurity (AOP) is one of exclusion. All causes of secondary apnea must be ruled out before initiating treatment for AOP. Treatment will depend on the etiology as well as effectiveness and tolerability of the treatment by the patient. The primary goal of any treatment of AOP is to prevent the frequency of apnea lasting >20 seconds, and/or those that are shorter, but associated with cyanosis and bradycardia. The clinical management of AOP is not much different today than it was two decades ago, with pharmacologic and nonpharmacologic treatment options remaining the mainstay of therapy. Methylxanthines are still the most widely used pharmacologic agents. Due to the wider therapeutic index of caffeine and ease of once daily administration, it should be the preferred agent. Doxapram, or nonpharmacologic treatment measures such as nasal continuous positive airway pressure, may be considered in infants who are unresponsive to methylxanthine treatment alone. Treatment should be continued until there is complete resolution of apnea, and for some time thereafter. The choice of method for weaning treatment remains one of individual physician preference. Discharge from hospital after apnea requires close monitoring and some infants will require home apnea monitors. The decision to provide a home apnea monitor should be individualized for each patient, depending on the effectiveness of treatment and clinical response.

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“…Although the maintenance dose of caffeine does not affect cerebral hemodynamics [17] , each patient was studied at least 12 h after the administration of the last caffeine dose.…”

Section: Patientsmentioning

confidence: 99%

Brain Hemodynamic Effects of Doxapram in Preterm Infants

Dani¹,

Bertini²,

Pezzati³

et al. 2006

Neonatology

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Background: Doxapram is a respiratory stimulant widely used for the treatment of idiopathic apnea of prematurity, although it has been demonstrated that it can induce a transient decrease of cerebral blood flow and that isolated mental delay in infants weighing <1,250 g is associated with the total dosage and duration of doxapram therapy. Objectives: To evaluate the effects of doxapram on cerebral hemodynamics in preterm infants using cerebral Doppler ultrasonography and near-infrared spectroscopy. Methods: Preterm infants who required treatment with doxapram for apnea of prematurity unresponsive to caffeine were treated with doxapram at an hourly dose of 0.5 mg·kg^–1·h^–1, followed by 1.5 and 2.5 mg·kg^–1·h^–1. Results: 20 preterm infants were studied. Doxapram induced a significant decrease of oxygenated hemoglobin (O₂Hb) and cerebral intravascular oxygenation (HbD = O₂Hb – HHb) and an increase of HHb and CtOx concentrations, while cerebral blood volume and cerebral blood flow velocity did not change. Conclusions: Doxapram infusion induces the increase of cerebral oxygen consumption and requirement and the contemporary decrease of oxygen delivery probably mediated by a decrease of cerebral blood flow. Caution must be recommended in prescribing this drug for apnea of prematurity.

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Brain Hemodynamic Changes in Preterm Infants after Maintenance Dose Caffeine and Aminophylline Treatment

Cited by 51 publications

References 22 publications

Haemodynamic changes in the brain after vaginal delivery and caesarean section in healthy term infants

Haemodynamic changes in the brain after vaginal delivery and caesarean section in healthy term infants

Treatment of Apnea of Prematurity

Brain Hemodynamic Effects of Doxapram in Preterm Infants

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