Treating Apnea of Prematurity

Abstract

Premature babies often suffer apnea of prematurity as a physiological consequence of an immature respiratory system. Hypercapnia may develop, and neonates with apnea of prematurity are at an increased risk of morbidity and mortality. The long-term effects of apnea of prematurity or their treatments are less clear. While a number of treatment options exist for apnea of prematurity, there is no clear-cut "first-line" approach or gold standard of care. Effective treatments, such as caffeine citrate, carbon dioxide inhalation, nasal continuous positive airway pressure, nasal intermittent positive pressure ventilation, and others, may be associated with safety concerns. More conservative treatments are available, such as kangaroo care, postural changes, and sensory stimulation, but they may not be effective. While apnea of prematurity resolves spontaneously as the respiratory system matures, it can complicate neonatal care and may have both short-term and long-term consequences. The role, if any, that apnea of prematurity may play in mortality of preterm neonates is not clear.

Extracellular Nicotinamide Phosphoribosyltransferase Is a Therapeutic Target in Experimental Necrotizing Enterocolitis

“…To develop NEC, a well-characterized rat model was used [16,[57][58][59]. The formula/hypoxia/hypothermia model of NEC was chosen because it most closely mimics the risk factors for NEC: prematurity, formula feeding, and stress (modeling apnea of prematurity [60,61] a common condition of premature infants, and the inability of preemies to adequately regulate temperature [62,63]. Specifically, for each of the two separate studies, pups from 3-5 timed-pregnant Sprague-Dawley rats (Charles River, Hollister, CA, USA) were delivered via C-section one day prior to scheduled birth.…”

The effect of doxapram on survival and APGAR score in newborn puppies delivered by elective caesarean: A randomized controlled trial

“…In this small study of 21 infants (11 assigned to intravenous doxapram and 10 to placebo), the results were equivocal although the study was likely underpowered due to its size. Subsequent studies and reviews on the use of doxapram in human infants, usually for apnoea of prematurity, have provided a variety of viewpoints including a recommendation that it appears to be an effective second‐line drug (behind methylxanthines such as caffeine) with uncertain side effects (Natarajan et al, 2010); that it not be used routinely due to its side effects and unclear long term benefits (Zhao et al, 2011); that it is used cautiously until its safety profile is better understood (Prins et al, 2013); that it may be used effectively but placebo‐controlled studies are needed to assess its safety and efficacy (Flint et al, 2017); that routine use cannot be recommended and that large multicentre randomized trials are urgently needed (Vliegenthart et al, 2017); and, most recently, that doxapram is known to be effective but may be associated with adverse side effects (Pergolizzi et al, 2022).…”

A Cafeína Como Droga De Primeira Escolha No Tratamento De Recém-Nascidos Prematuros Com Apneia

“…As metilxantinas são as drogas estimulantes do sistema nervoso central (SNC) aprazadas para o tratamento da AP visto que possuem ação antagonista aos receptores de adenosina A1 e A2A, promovendo efeitos complementares sobre os neurotransmissores que atuam estimulando as áreas respiratórias no tronco encefálico. Os primeiros medicamentos a serem utilizados foram a teofilina e a aminofilina, no entanto a cafeína foi considerada a mais eficaz tornando-se o fármaco de primeira escolha a nível mundial devido sua longa meia-vida que auxilia na função diafragmática, facilitando a extubação e reduzindo a neovascularização retiniana 3,8,11 .…”