Continuous positive airway pressure versus theophylline for apnea in preterm infants

Henderson‐Smart, David J; Subramaniam, Prema; Davis, Peter G

doi:10.1002/14651858.cd001072

Cited by 35 publications

(16 citation statements)

References 11 publications

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“…That small trial (n = 20 infants) demonstrated benefit in those infants receiving theophylline. [155] Although there are no randomized, controlled trials of CPAP versus control/nonintervention in the treatment of AOP, this is a therapy that is used frequently. In 1976, Speidel and Dunn [156] demonstrated in five preterm infants, that with the application of nasopharyngeal CPAP (2-3mm mercury), a 'clearly demonstrable' decrease in the number of episodes of apnea >20 seconds was evident.…”

Section: Nonpharmacologic Managementmentioning

confidence: 99%

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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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Section: Nonpharmacologic Managementmentioning

confidence: 99%

“…Since mask CPAP is no longer used clinically, this trial cannot be considered clinically germane. [155] Other nonpharmacologic means for controlling or treating apnea in premature infants have been studied. There are several early reports of apnea associated with environmental temperature.…”

Section: Nonpharmacologic Managementmentioning

confidence: 99%

Treatment of Apnea of Prematurity

Bhatt‐Mehta

Schumacher

2003

Pediatric Drugs

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“…Two recent randomized studies have confirmed that nCPAP is an alternative therapy to intubation, surfactant and mechanical ventilation for preterm infants [1,2]. Likewise, nCPAP has been successfully used in preterm infants following extubation and for apnea [3,4]. In larger, more mature newborns, nCPAP has been used to treat a variety of causes of respiratory distress, including meconium aspiration syndrome, transient tachypnea of the newborn and pneumonia [5].…”

Section: Introductionmentioning

confidence: 99%

A Comparison of two nasal continuous positive airway pressure interfaces – a randomized crossover study

Bushell

McHugh

Meyer

2013

Journal of Neonatal-Perinatal Medicine

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BACKGROUND: In spite of widespread use of nasal CPAP there are comparatively few studies to guide the choice of nasal prongs. OBJECTIVES: To determine whether the Fisher & Paykel Healthcare (FPH) neonatal continuous positive airway pressure (CPAP) interface was effective in providing bubble CPAP when compared to the Hudson prong interface. METHODS:The study was a randomized cross-over study of twenty newborn infants 500 g or more requiring CPAP for respiratory support at birth. Infants were randomized to either the Fisher & Paykel Healthcare or Hudson CPAP interface for twenty four hours. Crossover between interfaces occurred after subsequent twenty four hour periods. The primary outcome was the provision of desired CPAP pressures, defined as provision of CPAP within ± one cm H 2 O of set pressure. RESULTS: The percentage time CPAP was within ± one cm H 2 O of set pressure was 66.5% for the Hudson and 71.8% for the FPH interface (p = 0.66). Oxygen saturations for the Hudson interface were in target range for a median of 97.8% of the time, and, with the FPH interface, for a median of 98.2% of the time (p = 0.76). Clinically significant differences in primary or secondary outcomes between the two groups were not detected. CONCLUSIONS: The nasal CPAP interfaces studied were equally effective in achieving desired bubble CPAP pressures and target saturations.

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“…15 At CPAP level of 5 cm water, infants with AOP will have fewer episodes. This reduction is primarily related to significant reduction in episodes of obstructive and mixed apneas and has been attributed to splinting open of the upper airways by the positive airway pressure.…”

Section: Continuous Positive Airway Pressurementioning

confidence: 99%

Apnea in the newborn

et al. 2008

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Apnea, defined as cessation of breathing resulting in pathological changes in heart rate and oxygen saturation, is a common occurrence especially in preterm neonates. It is due to immaturity of the central nervous system (apnea of prematurity) or secondary to other causes such as metabolic disturbances etc. Secondary causes of apnea should be excluded before a diagnosis of apnea of prematurity is made. Methylxanthines and continuous positive airway pressure form the mainstay of treatment. Mechanical ventilation is reserved for apnea resistant to the above therapy. An approach to the management of apnea in neonates is described.

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Continuous positive airway pressure versus theophylline for apnea in preterm infants

Cited by 35 publications

References 11 publications

Treatment of Apnea of Prematurity

Treatment of Apnea of Prematurity

A Comparison of two nasal continuous positive airway pressure interfaces – a randomized crossover study

Apnea in the newborn

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