Kinesthetic stimulation versus theophylline for apnea in preterm infants.
BACKGROUND
Apnea of prematurity may lead to hypoxemia and bradycardia requiring resuscitative measures being instituted. Many treatments have been used in infants with apnea of prematurity, such as theophylline. Kinesthetic stimulation, which uses various forms of oscillating mattress, might also prevent apnea without using a standard drug such as theophylline.


OBJECTIVE
Main question: in preterm infants, how does kinesthetic stimulation compare with methylxanthine therapy in the treatment of apnea of prematurity.


METHODS
The standard search strategy of the Neonatal Review Group was used. This included searches of the Oxford Database of Perinatal Trials, Cochrane Controlled Trials Register, MEDLINE, previous reviews including cross references, abstracts, conferences and symposia proceedings, expert informants and journal handsearching mainly in the English language.


METHODS
All trials using random or quasi-random patient allocation, in which kinesthetic stimulation was compared to methylxanthine therapy for apnea of prematurity, were eligible. No trials were excluded from the review that met these criteria.


METHODS
Standard methods of the Cochrane Collaboration and its Neonatal Review Group were used with separate evaluation of trial quality, data extraction by both authors and synthesis of data using relative risk and weighted mean difference.


RESULTS
A single small study of 20 infants (Saigal 1986) demonstrated a significant benefit to the infants receiving theophylline compared to those on an oscillating water bed in terms of mean rates of clinically important apnea (apnea > 14 seconds and bradycardia < 100, and cyanosis or receiving stimulation). There were no significant differences in adverse effects (death, sleep states, the Albert Einstein Neurobehavioural Index, adverse neurological outcomes, and the Bayley Mental Development Index at six and 12 months), although the infants on the OWB had a higher psychomotor index at six but not 12 months. There were some differences between the groups in incidence and severity of respiratory distress syndrome, and baseline apnea rates.


CONCLUSIONS
The results of this review should be treated with caution. Theophylline has been shown in one small study to be superior to kinesthetic stimulation at treating clinically important apnea of prematurity. There are currently no clear research questions regarding the comparison of methylxanthines and kinesthetic stimulation to treat apnea of prematurity.
Osborn
D A
DA
Department of Neonatal Medicine, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, Sydney, NSW, Australia, 2050. davido@peri.rpa.cs.nsw.gov.au.
Henderson-Smart
D J
DJ
D001049:Apnea / Q000628:therapy*; D001513:Beds; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000628:therapy*; D018953:Kinesiology, Applied; D010812:Physical Stimulation / Q000295:instrumentation*; D013806:Theophylline / Q000627:therapeutic use*; D014970:Xanthines / Q000627:therapeutic use*
D000697:Central Nervous System Stimulants; D014970:Xanthines; C008514:methylxanthine; D013806:Theophylline