Doxapram versus methylxanthine for apnea in preterm infants.
BACKGROUND
Recurrent apnea is common in preterm infants, particularly at very early gestational ages. These episodes of loss of effective breathing can lead to hypoxemia and bradycardia which may be severe enough to require resuscitation including use of positive pressure ventilation. Doxapram and methylxanthine drugs have been used to stimulate breathing and so prevent apnea and its consequences.


OBJECTIVE
To assess the effects of doxapram compared with methylxanthine in preterm infants with recurrent apnea.


METHODS
The Cochrane Collaboration Clinical Trials Register (Cochrane Library issue 3, 2000), MEDLINE (1966- July 2000), reference lists of relevant articles and conference proceedings.


METHODS
Randomized and quasi-randomized trials of doxapram compared with methylxanthine (e.g. theophylline, aminophylline or caffeine) for the treatment of apnea in preterm infants.


METHODS
The methodological quality of each trial was reviewed by the second reviewer blinded to trial authors and institution(s). Additional information was requested from authors. Each reviewer extracted the data separately, then they were compared and differences resolved. Meta-analysis was carried out with use of relative risk and risk difference.


RESULTS
Three trials involving 56 infants were included. No difference was detected between intravenous doxapram or methylxanthine in the incidence of failed treatment within 48 hours (relative risk 1.16, 95% confidence interval 0.43 to 3.13). No infants were reported to have been given mechanical ventilation on either treatment. No adverse effects were reported.


CONCLUSIONS
Intravenous doxapram and intravenous methylxanthine appear to be similar in their short term effects for treating apnea in preterm infants, although these trials are too small to exclude an important difference between the two treatments or to exclude the possibility of less common adverse effects. Longer term outcome of infants treated in these trials has not been reported. Further studies would require a large number of infants to clarify whether there might be differences in responses or adverse effects with these two drugs at different ages.
Henderson-Smart
D J
DJ
NSW Centre for Perinatal Health Services Research, Queen Elizabeth II Institute for Mothers and Infants, Building DO2, University of Sydney, Sydney, NSW, AUSTRALIA, 2006. dhs@mail.usyd.edu.au
Steer
P
P
D000628:Aminophylline / Q000627:therapeutic use; D001049:Apnea / Q000188:drug therapy*; D004315:Doxapram / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D019141:Respiratory System Agents / Q000627:therapeutic use*; D013806:Theophylline / Q000627:therapeutic use*; D014970:Xanthines / Q000627:therapeutic use*
D019141:Respiratory System Agents; D014970:Xanthines; D000628:Aminophylline; D004315:Doxapram; D013806:Theophylline