Isolated mental developmental delay in very low birth weight infants: Association with prolonged doxapram therapy for apnea

Sreenan, Con; Etches, Phillip C.; Demianczuk, Nestor; Robertson, Charlene M.T.

doi:10.1067/mpd.2001.119592

Cited by 65 publications

(34 citation statements)

References 28 publications

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“…In addition, 130 studies were excluded for the reasons mentioned in figure 1. This left 32 studies for the final analyses, 4 RCTs [13,14,15,16], 1 prospective crossover study [17], 2 case-control studies [18,19], and 25 cohort, case series or case reports studies [20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44]. Four studies were only available in abstract form [19,23,24,38].…”

Section: Resultsmentioning

confidence: 99%

Doxapram Treatment for Apnea of Prematurity: A Systematic Review

et al. 2016

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Background: Apnea of prematurity (AOP) is a common complication of preterm birth, for which caffeine is the first treatment of choice. In case of persistent AOP, doxapram has been advocated as an additional therapy. Objective: To identify and appraise all existing evidence regarding efficacy and safety of doxapram use for AOP in infants born before 34 weeks of gestational age. Methods: All studies reporting on doxapram use for AOP were identified by searching electronic databases, references from relevant studies, and abstracts from the Societies for Pediatric Research. Two reviewers independently assessed study eligibility and quality, and extracted data on study design, patient characteristics, efficacy and safety outcomes. Results: The randomized controlled trials showed less apnea during doxapram treatment when compared to placebo, but no difference in treatment effect when compared to theophylline. No serious adverse effects were reported. We identified 28 observational studies consisting mainly of cohort studies and case series (n = 1,994). There was considerable heterogeneity in study design and quality. Most studies reported a positive effect of doxapram on apnea rate. A few studies reported on long-term outcomes with conflicting results. A range of possible doxapram-related short-term adverse effects were reported, sometimes associated with the use of higher doses. Conclusion: Based on the limited number of studies and level of evidence, no firm conclusions on the efficacy and safety of doxapram in preterm infants can be drawn. For this reason, routine use cannot be recommended. A large multicenter randomized controlled trial is urgently needed to provide more conclusive evidence.

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Section: Resultsmentioning

confidence: 99%

Doxapram Treatment for Apnea of Prematurity: A Systematic Review

et al. 2016

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“…Neonates suffered cardiovascular collapse and death associated with metabolic acidosis, thrombocytopenia, gasping respirations, central nervous system depression, hepatic and renal failure due to benzyl alcohol poisoning. The toxic threshold was determined to be 130 mg/kg/day (5 A recent case-control study reported that decreased mental capacity in very low birth weight infants that had been treated with doxapram correlated with the amount of doxapram they had received (49). The mechanism of this decrease is unclear.…”

Section: Use In Apnea Of the Newbornmentioning

confidence: 99%

A New Look at the Respiratory Stimulant Doxapram

2006

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A number of life-threatening clinical disorders may be amenable to treatment with a drug that can stimulate respiratory drive. These include acute respiratory failure secondary to chronic obstructive pulmonary disease, post-anesthetic respiratory depression, and apnea of prematurity. Doxapram has been available for over forty years for the treatment of these conditions and it has a low side effect profile compared to other available agents. Generally though, the use of doxapram has been limited to these clinical niches involving patients in the intensive care, post-anesthesia care and neonatal intensive care units. Recent basic science studies have made considerable progress in understanding the molecular mechanism of doxapram's respiratory stimulant action. Although it is unlikely that doxapram will undergo a clinical renaissance based on this new understanding, it represents a significant advance in our knowledge of the control of breathing.

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“…This might result in decreased cerebral perfusion and damage to the developing brain, leading to long-term developmental delay. 67 Therefore, doxapram is not currently recommended for the treatment of AOP. …”

Section: Doxaprammentioning

confidence: 99%

Apnea of prematurity: challenges and solutions

Picone¹,

Aufieri²,

Paolillo³

2014

RRN

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Apnea of prematurity is a developmental disorder that frequently affects preterm infants, especially those with lower gestational age. Even if apnea of prematurity is by definition a self-limiting condition, it can cause serious problems during the hospital stay and can potentially have long-term neurological and cognitive consequences depending on the severity and intensity of the episodes. The diagnosis of apnea of prematurity can be made only after excluding a number of diseases of the preterm infant in which apnea may be an epiphenomenon. Etiological diagnosis is essential for selection of appropriate treatment, which may be nonpharmacological or involve use of drugs.

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Isolated mental developmental delay in very low birth weight infants: Association with prolonged doxapram therapy for apnea

Cited by 65 publications

References 28 publications

Doxapram Treatment for Apnea of Prematurity: A Systematic Review

Doxapram Treatment for Apnea of Prematurity: A Systematic Review

A New Look at the Respiratory Stimulant Doxapram

Apnea of prematurity: challenges and solutions

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