Premium
Interventions for apnoea of prematurity: a personal view
Author(s) -
Poets CF
Publication year - 2010
Publication title -
acta pædiatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/j.1651-2227.2009.01604.x
Subject(s) - medicine , continuous positive airway pressure , retinopathy of prematurity , work of breathing , bradycardia , prone position , anesthesia , psychological intervention , intensive care medicine , mechanical ventilation , pregnancy , heart rate , gestational age , blood pressure , obstructive sleep apnea , psychiatry , biology , genetics
Aim: To review treatments for apnoea of prematurity (AOP). Methods: Literature Review and description of personal practice. Results: Provided that symptomatic apnoea has been ruled out, interventions to improve AOP can be viewed as directed at one of three underlying mechanisms: (i) a reduced work of breathing [e.g. prone positioning, nasal continuous positive airway pressure (CPAP)], (ii) an increased respiratory drive (e.g. caffeine), and (iii) an improved diaphragmatic function (e.g. branched‐chain amino acids). Most options currently applied, however, have not yet been shown to be effective and/or safe, except for prone, head‐elevated positioning, synchronized nasal ventilation/CPAP, and caffeine. Conclusion: Treatment usually follows an incremental approach, starting with positioning, followed by caffeine (which should be started early, at least in infants <1250 g), and nasal ventilation or CPAP via variable flow systems that reduce work of breathing. From a research point of view, we most urgently need data on the frequency and severity of bradycardia and intermittent hypoxia that can yet be tolerated without putting an infant at risk of impaired development or retinopathy of prematurity.