Limitations of theophylline in the treatment of apnea of prematurity. Apnoea of immaturity. 1. A controlled trial of theophylline and face mask continuous positive airways pressure. The effect of vertical pulsating stimulation on apnea of prematurity.
Theophylline is commonly used to treat apnea of prematurity. To determine the effectiveness of theophylline with respect to gestational and postnatal age, we conducted a controlled study in 43 premature infants with idiopathic apnea. Three of the 21 treated and eight of the 22 control infants developed respiratory failure. Eight of the 11 infants with respiratory failure had gestational ages of less than 31 weeks and had more than four apneic episodes during the first day of life. In the treated infants without respiratory failure, the number of apneic episodes by 24-hour intervals declined six days earlier than in the control infants. Apnea disappeared, however, at a similar time in both groups. Three treated infants and three control infants had apneic episodes persisting beyond the neonatal period. Patients treated with theophylline did not develop respiratory failure as often as control infants did. However, despite a reduction of apneic episodes, theophylline did not shorten the course of apnea of prematurity. A randomised controlled trial of theophylline versus face-mask continuous positive airways pressure (CPAP) treatment for recurrent apnoea of immaturity was carried out in 32 infants of 25 to 32 weeks' gestation. Continuous recording of electrocardiogram and impedence pneumogram added objective assessment to the nurses' observations for 11 courses of treatment. The CPAP group had more adverse perinatal factors but the frequency of apnoeic attacks before treatment was comparable. Infants given theophylline had a greater reduction in the incidence of prolonged apnoeic attacks, and this difference persisted after allowing for the effect of perinatal complications. Continuous recordings showed a greater reduction in episodes of bradycardia of less than or equal to 80/minute with theophylline. Five of 18 infants given theophylline needed intermittent positive pressure ventilation for apnoea compared with 12 of 14 given CPAP. The poor response in 17 of 32 infants suggests a need for a more effective method of preventing or treating apnoea in very immature babies, in whom adverse perinatal factors often coexist. Placing preterm infants suffering idiopathic apnea of prematurity on the VPS had an effect on the infants' respiratory effort and achieved a reduction in the number of apneic episodes secondary to central and mixed apnea. However, VPS offered no benefits in the reduction of obstructive apnea in this study population. Because central apnea has been reported as the predominant type of apnea and VPS is a nontoxic, noninvasive, and easy-to-implement method of alleviating central and mixed apnea types, it seems prudent to give VPS which has the stimulus characteristics to preterm infants experiencing apnea of prematurity before other treatment modalities currently in use are tried. Further studies are warranted to determine if VPS is effective in a continuous long-term treatment for apnea of prematurity, for example, until the end of apnea.
There is insufficient evidence to recommend kinesthetic stimulation as treatment for clinically significant apnea of prematurity. Previous reviews have suggested that kinesthetic stimulation is not effective at preventing apnea of prematurity (Henderson-Smart 2005) and is not as effective as theophylline at treating clinically significant apnea of prematurity (Osborn 2005).