title: Effect of doxapram on episodes of apnoea, bradycardia and hypoxaemia in preterm infants.
abstract: OBJECTIVE
  To study the effect of doxapram on the frequency of apnoea, bradycardia and hypoxaemia.
  
  
  METHODS
  Fifteen infants, median gestational age at birth 27 weeks (range 24-30), age at study 27 days (12-60), with >/=6 episodes of bradycardia or hypoxaemia/6 h despite serum caffeine levels in the therapeutic range, received doxapram either intravenously (0.5-2 mg/kg/h) or orally (2-8 mg/kg every 2 h). Six-hour recordings of pulse oximeter saturation (S(P)O(2)), pulse waveforms, ECG, breathing movements and nasal airflow were performed immediately before as well as 1, 3 and 6 days after onset of treatment. Recordings were analysed for apnoea (>/=4 s), bradycardia (heart rate < 2/3 of baseline) and hypoxaemia (S(P)O(2) </=80%).
  
  
  RESULTS
  There was no difference between enteral and intravenous administration; results are therefore presented for the total group. Doxapram resulted in a significant decrease in the frequency of apnoea [22 (11-27) vs. 14 (7-23)/h, p < 0.01], bradycardia [3 (0-7) vs. 1 (0-3)/h, p < 0.01] and hypoxaemia [8 (0-18) vs. 2 (0- 17)/h, p < 0.01] already after 1 day of treatment, which was sustained throughout the 6-day study period. Side effects included an increase in the proportion of time spent awake [5 (0-24) vs. 12% (3-28), p < 0.01] and in gastric residuals [0% of feeding volume (0-5) vs. 4% (0-19), p < 0.05]. Enteral was switched to intravenous doxapram in 3 of 9 infants because of gastrointestinal side effects.
  
  
  CONCLUSIONS
  Doxapram substantially reduced the frequency of apnoea, bradycardia and hypoxaemia in these patients with caffeine-resistant apnoea of prematurity. Enteral administration, however, was not tolerated in a significant proportion (33%) of infants.
authors.affiliation: Department of Neonatology and Paediatric Pulmonology, Hannover Medical School, Hannover, Germany. poets.christian@mh-hannover.de
authors.forename: C F
authors.initials: CF
authors.lastname: Poets
authors.forename: S
authors.initials: S
authors.lastname: Darraj
authors.forename: B
authors.initials: B
authors.lastname: Bohnhorst
mesh_terms: D001049:Apnea / Q000517:prevention & control*; D001724:Birth Weight; D001919:Bradycardia / Q000517:prevention & control*; D002110:Caffeine / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use; D004315:Doxapram / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004351:Drug Resistance; D005865:Gestational Age; D006801:Humans; D000860:Hypoxia / Q000517:prevention & control*; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000517:prevention & control*; D007262:Infusions, Intravenous; D007441:Intubation, Gastrointestinal; D010100:Oxygen / Q000097:blood; D019141:Respiratory System Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D019141:Respiratory System Agents; D002110:Caffeine; D004315:Doxapram; D010100:Oxygen