Essential Neonatal Medicine by Sunil Sinha & Lawrence Miall & Luke Jardine

Author:Sunil Sinha & Lawrence Miall & Luke Jardine
Language: eng
Format: epub
Published: 2017-06-29T00:00:00+00:00

Stimulation

Tactile stimulation by regular stroking of the infant has been shown to reduce the number of apnoeic episodes, but this is not a feasible method for routine use. In the past, a variety of rocking mattresses that gently rock or undulate the baby have been used; although these appeared to reduce the frequency of apnoea, they have been largely replaced.

Drug treatment

This is only indicated when specific causes of apnoea have been treated. They are frequently prescribed in extremely preterm infants prior to extubation. Drugs for apnoea are usually continued until the baby is 32–34 weeks of gestational age.

Caffeine citrate is now the drug of choice for apnoea of prematurity. Its mechanism of action is not certain. Possibilities include increased chemoreceptor responsiveness, enhanced respiratory muscle performance, and generalized central nervous system excitation. The main mechanism of action appears to occur centrally as a respiratory stimulant. An initial loading dose (given intravenously or orally) is followed by a daily dose. Serum levels of caffeine do not need to be routinely monitored but can be considered if there are any side effects. While caffeine does reduce the rate of apnoea, the major benefit is that it improves the rate of survival without neurodevelopmental disability at 18–21 months in infants with VLBW.

Older methylxanthines such as theophylline and aminophylline are still used in some centres. Tachycardia and irritability are the first signs of overdosage. Doxapram has been used only in selected infants in whom recurrent apnoea cannot be controlled by methylxanthines. Extreme jitteriness is a well-recognized side effect.

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