Risks and benefits of therapies for apnoea in premature infants

Apnoea in infants can result from a wide range of causes, and requires thor ough evaluation before deciding on appropriate treatment. Continuous monito ring of premature infants with apnoea is mandatory in order to define the p athophysiology and type of apnoea; selection of treatment involves careful assessment of aetiology, as well as efficacy and tolerability in each indiv idual case. The objective of treatment is to prevent the deleterious conseq uences of apnoeas that last >20 seconds and/or are associated with bradycar dia, cyanosis or pallor, and occur more often than once an hour over a 12-h our period. Apnoea management involves both pharmacological and nonpharmacological trea tment. We suggest methylxanthines as first-line therapy for idiopathic apno eas; evidence suggests that caffeine is better tolerated and as efficacious as theophylline (since it is particularly efficacious against the 'central ' component of idiopathic apnoea of prematurity). If treatment fails, addit ional measures such as doxapram may be appropriate when hypoventilation is present, or nasal continuous positive air way pressure when upper airway in stability or obstructive apnoeas are predominant. Apnoea prophylaxis is an additional reason to advocate prenatal maturation with betamethasone. Weani ng from treatment is attempted 4 to 5 days after complete resolution of apn oea, beginning with the last treatment introduced. Monitoring should be mai ntained for 4 to 5 days to detect any relapse of recurrent and severe apnoe as, which would lead to the resumption of the most recently withdrawn treat ment.