LOW-DOSE DOXAPRAM FOR TREATMENT OF APNEA FOLLOWING EARLY WEANING IN VERY-LOW-BIRTH-WEIGHT INFANTS - A RANDOMIZED, DOUBLE-BLIND-STUDY

The effects of low-dose doxapram (0.5 mg kg(-1) h(-1)) in combination with caffeine were evaluated on apnoea frequency following weaning fro m mechanical ventilation, and on blood pressure, in very low birthweig ht (BW) premature infants. Twenty-nine infants with BW less than or eq ual to 1250 g, gestational age at birth (GA) <34 weeks and postnatal a ge <5 d, who required minimal respiratory support, were included. Foll owing randomization, they received a loading dose of caffeine citrate and a continuous infusion of doxapram (doxapram, n = 14) or placebo (n = 15) was started. They were extubated 8 h after starting the infusio n, which was continued for 5 d. During this period, weaning was well t olerated in both groups, apnoeas occurred less frequently and there wa s a greater increase in systolic blood pressure in infants treated wit h doxapram than in controls. Plasma doxapram levels were also higher t han expected. It is therefore suggested that doxapram, even at low dos es,should not be used during the first few days of life. Careful monit oring of blood pressure is required if doxapram is used later.