Retrospective study shows that doxapram therapy avoided the need for endotracheal intubation in most premature neonates

Flint, Robert B.; Halbmeijer, Nienke M.; Meesters, Naomi; Rosmalen, Joost van; Dijk, Monique van; Simons, Sinno

doi:10.1111/apa.13761

Cited by 14 publications

(14 citation statements)

References 29 publications

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“…Previous studies have shown that doxapram reduces apnea frequency and the need for invasive mechanical ventilation [4]. However, a recent systematic review, based on a small number of studies with mainly low quality of evidence, indicated that no firm conclusions can be drawn on the efficacy and safety of doxapram [7].…”

Section: Discussionmentioning

confidence: 99%

“…Doxapram is an analeptic drug that stimulates peripheral chemoreceptors in the carotid bodies as well as the central chemoreceptors in the respiratory center in the brainstem [3]. Previous research has shown that infusion of doxapram is effective in reducing apneic events and preventing respiratory insufficiency requiring intubation and invasive mechanical ventilation [4]. Furthermore, some small physiological studies have shown an increase in minute ventilation and tidal volume after infusion of doxapram, but only if dosed > 1 mg/kg/h [5, 6].…”

Section: Introductionmentioning

confidence: 99%

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Doxapram Treatment and Diaphragmatic Activity in Preterm Infants

et al. 2018

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Background: Doxapram is a treatment option for severe apnea of prematurity (AOP). However, the effect of doxapram on the diaphragm, the main respiratory muscle, is not known. Objectives: To investigate the effect of doxapram on diaphragmatic activity measured with transcutaneous electromyography of the diaphragm (dEMG). Methods: A pilot study was conducted in a tertiary neonatal intensive care unit. Diaphragmatic activity was measured from 30 min before up to 3 h after the start of doxapram treatment. dEMG parameters were compared to baseline (5 min before doxapram treatment) and at 15, 60, 120 and 180 min after the start of doxapram infusion. Results: Eleven preterm infants were included with a mean gestational age of 25.5 ± 1.2 weeks and birth weight of 831 ± 129 g. The amplitude_dEMG, peak_dEMG and tonic_dEMG values did not change in the 3 h after the start of doxapram infusion compared to baseline. Clinically, the number of apnea episodes in the 24 h after doxapram treatment decreased significantly. Conclusion: Doxapram infusion does not alter diaphragmatic activity measured with transcutaneous dEMG in preterm infants with AOP, indicating that its working mechanism is primarily on respiratory drive and not on respiratory muscle activity.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Doxapram Treatment and Diaphragmatic Activity in Preterm Infants

et al. 2018

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“…A positive effect of doxapram and-to a lesser extent of keto-doxapram-on the respiratory drive was also found in newborn lambs (Bairam et al, 1990). Two retrospective studies concluded that doxapram therapy may avoid mechanical ventilation (Prins et al, 2013;Flint et al, 2017a). In our earlier studies, doxapram therapy had a positive effect on the SpO 2 , the applied FiO 2 (Flint et al, 2017b), the oxygen need (SpO 2 /FiO 2 ratio), and hypoxia (cumulative oxygen shortage under the 89% limit) (Poppe et al, 2019).…”

Section: Discussionmentioning

confidence: 78%

Precision Dosing of Doxapram in Preterm Infants Using Continuous Pharmacodynamic Data and Model-Based Pharmacokinetics: An Illustrative Case Series

et al. 2020

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Conclusion: Real-time and non-invasive effect monitoring of drug therapy combined with model-based exposure provides relevant information to clinicians and can importantly improve therapy. The variability between and within patients emphasizes the importance of individual, objective evaluation of pharmacotherapy. These measurements, together with data on ADRs, allow for precision medicine in neonatology that should be brought to the bedside.

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“…In summary, it appears that doxapram therapy is beneficial in infants with persistent AOP despite caffeine and optimal care, but randomized controlled trials are lacking, and the late outcomes of premature infants treated with doxapram for AOP are unclear. 77,[79][80][81]…”

Section: Doxaprammentioning

confidence: 99%

Apnea of Prematurity: An Update

Gileles‐Hillel

Erlichman

Reiter

2019

JCS

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Apnea of prematurity (AOP) affects the majority of infants born prematurely, before 34 weeks of gestational age. AOP is a common diagnosis in the neonatal intensive care unit and one of significant clinical importance, both immediate and long term, as it is associated with reduced survival and poorer respiratory and neurodevelopmental outcomes. In this review, we provide an up-to-date summary of recent advances in the understanding of the pathophysiology of AOP, as well as the clinical questions relevant to physicians and staff treating infants with AOP. Finally, we discuss monitoring and discharge decisions, as these are areas of significant uncertainty.

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Retrospective study shows that doxapram therapy avoided the need for endotracheal intubation in most premature neonates

Abstract: Oral and intravenous doxapram effectively treated most cases of apnoea in preterm infants, avoiding the need for intubation.

Cited by 14 publications

References 29 publications

Doxapram Treatment and Diaphragmatic Activity in Preterm Infants

Doxapram Treatment and Diaphragmatic Activity in Preterm Infants

Precision Dosing of Doxapram in Preterm Infants Using Continuous Pharmacodynamic Data and Model-Based Pharmacokinetics: An Illustrative Case Series

Apnea of Prematurity: An Update

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