Neonatal Apnea:Treatment Protocol,Pharmacologic Therapy

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

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Results

NEONATAL APNEA

Related topics

Definition,Types and Incidence

Etiology,Pathophysiology and Physiologic Effects

Evaluation Of Apneic Infant

Monitoring and Principles Of Therapy

Discharge Planning and Follow Up

Bodhankar Uday
President ISTP, SCM IPA, Asst. Professor Pediatrics,
Ramdaspeth, Nagpur, India. GMCH, Nagpur, India

TREATMENT PROTOCOL :

Institution of interventions should occur in the order of increasing invasiveness and risk.

Diagnose and treat precipitating causes: respiratory diseases, hypertension, sepsis, anemia, hypoglycemia
Initiate stimulation (cutaneous, vestibular)
Initiate a trial of nasal prong air/oxygen airflow
Initiate a trial of low-pressure nasal continuous positive airway pressure (CPAP)
Initiate methylxanthine therapy
Initiate mechanical ventilation

Pharmacologic therapy : The most common drugs used to treat apnea are the methylxanthines: Caffeine and Theophylline (8). Aminophylline is Theophylline combined with Ethylenediamine to increase water solubility.

Mechanism of Action

Methylxanthines block adenosine receptors. Adenosine inhibits the respiratory drive, thus by blocking inhibition, the methylxanthines stimulate respiratory neurons resulting in an enhancement of minute ventilation, chemoreceptor sensitivity to CO2, and cardiac output.

Dosages

The following is a guide to the initiation of medical therapy. Further dosing should be based on drug levels and clinical response. (9,10)
Aminophylline

Loading dose
6 mg/kg PO or IV infusion over 30 min

Maintenance dose
1.5-3 mg/kg/dose IV or PO given q8-12 hr started 8-12 hours after loading dose.

Plasma half life
20-30 hours

Therapeutic level
6-13 mcg/ml. Obtain trough 48-72 hours after loading dose.

Toxic level
>20 mcg/ml

Caffeine

Loading dose
10 mg/kg PO

Maintenance dose
2.5 mg/kg per dose PO Q24 hours, started 24 hours after the loading dose. Note that doses for caffeine citrate are higher: Use 2X the caffeine base dose.

Plasma half life
40-230 hrs.

Therapeutic level
5-25 mcg/ml. Obtain trough level on day 5 or 6 after loading dose.

Toxic level
>40-50 mcg/ml

Next : Treatment Protocol(Contd.)

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