pediatrics
Apnea of Prematurity
Treatment of Apnea of Prematurity
Stimulation Treatment of underlying disorder Respiratory stimulants (eg,caffeine) Continuous positive airway pressure (CPAP) Patients are admitted to a monitored setting. When apnea is noted, either by observation or monitor alarm, infants are stimulated, which may be all that is required; if breathing does not resume, bag-valve-mask ventilation is provided (see Airway and Respiratory Devices ). Frequent or severe episodes should be quickly and thoroughly evaluated, and identifiable causes should be treated. If no infectious or other treatable underlying disorder is found, respiratory stimulants are indicated for treatment of frequent or severe episodes, characterized by hypoxemia, cyanosis, bradycardia, or a combination. Oralcaffeineis the safest and most commonly used respiratory stimulant drug.Caffeineis preferred because of ease of administration, fewer adverse effects, larger therapeutic window, and less need to monitor drug levels. Treatment continues until the infant is 34 to 35 weeks gestation and free from apnea requiring physical intervention for at least 5 to 7 days. Monitoring continues after the last episode of apnea or aftercaffeinehas been stopped until the infant has gone 5 to 10 more days without having apnea requiring intervention. If apnea continues despite respiratory stimulants, the infant may be given Continuous Positive Airway Pressure (CPAP) starting at 5 to 7 cm H2O pressure. Intractable apneic spells require ventilator support. Discharge practices vary; some practitioners observe infants for 7 days after treatment has ended to ensure that apnea or bradycardia does not recur, whereas others discharge withcaffeineif treatment seems effective. 