Effects of theophylline on the pattern of spontaneous breathing in preterm infants less than 1000 g of birth weight

Phosphodiesterase-4 inhibition attenuates pulmonary inflammation in neonatal lung injury

“…Beneficial effects are related to nonspecific inhibition of adenosine A1 and A2a receptors, stimulation of the respiratory centre and improved function of the respiratory muscles [46][47][48]. Theophylline treatment in premature infants improved lung function by stimulating spontaneous breathing, reducing the number of apnoeas and increasing tidal volumes [49]. Potential harmful effects of neonatal methylxanthine therapy on growth, neurological development and childhood behaviour were investigated in the Caffeine for Apnoea of Prematurity trial [50].…”

Antecedents of respiratory pauses in extremely low birth weightinfants supported by proportional assist ventilation

“…A clear-cut distinction cannot always be made between what is described as an apnea and other patterns of respiratory interruption [2]. In this study we defined a respiratory pause as a cessation of breathing for the duration of at least the three preceding breaths [11,12], because the preterm infants in our study were extremely immature and would not tolerate respiratory pauses of 10 seconds without ventilation. V 0 peak i , inspiratory peakflow; V 0 peak e , expiratory peakflow; V t /T i , mean inspiratory flow; T i , inspiratory time; T pi , time from onset to peak inspiratory flow; T ce , time from onset to cessation of expiratory flow; T i /T tot , inspiratory time divided by total cycle duration.…”

“…Three categories of breathing patterns were therefore distinguished for the evaluation of the recordings: (1) regular sinusoidal breathing; (2) sinusoidal breathing with occasional multiple inspiratory flow peaks; (3) irregular breathing. A respiratory pause was defined as cessation of spontaneous breathing for the mean duration of at least three breaths [11]. Mean total respiratory cycle duration was obtained over the entire recording disregarding periods of apnea and backupventilation.…”

“…This occurrence may enable the infant to use a breathing pattern as if there were no derangement of lung mechanics [10]. PAV therefore seems to be a suitable mode of ventilation to determine the endogenous breathing pattern of ventilated preterm infants [11][12][13]. However, backup conventional ventilation must be initiated during apneas.…”

Current definitions for neonatal apnoea: Are they evidence based?

“…In a study of the effect of theophylline on infants <1000 g, a ‘respiratory pause’ was defined as cessation of breathing for the duration of at least three preceding breaths. Episodes were termed apnoea if associated with cardiac slowing of more than 10% from baseline, or bradycardia below 100 beats/min or oxygen desaturation less than 85% . Sleep state has not generally been considered when these definitions of apnoea are used.…”