Treatment of severe theophylline toxicity with hemodialysis in a preterm neonate

Theophylline, a drug frequently used to treat apnea of prematurity, has a p rolonged half-life of 30 h in neonates. Severe overdoses of theophylline ha ve an associated 10% mortality and significant morbidity. We describe a 122 0-g neonate who developed status epilepticus due to a theophylline overdose . Hemodialysis was instituted to increase elimination of theophylline. The patient tolerated the procedure without complication. The half-life of theo phylline was 0.7 h during dialysis. No reported therapies used in neonates have achieved this magnitude of clearance. In fact, the clearance of theoph ylline in this neonate approached that obtained with hemoperfusion, the sta ndard therapy for theophylline overdose in adult patients. This case demons trates that hemodialysis is a safe and effective means of enhancing theophy lline elimination for neonatal theophylline overdose.