Aminophylline for the prevention of apnea during prostaglandin E1 infusion.
BACKGROUND
Apnea is associated with prostaglandin E1 infusion (PGE1) used in the palliation of ductal-dependent congenital heart lesions.


OBJECTIVE
Aminophylline is a central respiratory stimulant and will decrease the incidence of PGE1-associated apnea and the need for intubation for apnea in infants with ductal-dependent congenital heart disease.


METHODS
Informed consent was obtained for all patients. In a prospective, double-blinded, placebo-controlled study, newborn infants with ductal-dependent congenital heart disease were randomized to receive either aminophylline or placebo during initiation and maintenance of PGE1, which was started at 0.01 microg/kg/min and increased to 0.03 microg/kg/min. Aminophylline was given as a bolus dose of 6 mg/kg before or during initiation of PGE1, and continued at 2 mg/kg dose every 8 hours for 72 hours. Serum aminophylline levels were checked at 18 and 36 hours. The primary study endpoint was intubation for apnea, with a secondary endpoint of apnea, as defined as acute cessation of breathing with associated hypoxia and bradycardia.


RESULTS
The study evaluated 42 infants. The 2 groups were similar for gestational age, weight, hematocrit, and use of sedation. In the aminophylline group, serum levels were 7.6 +/- 1.2 microg/mL. No significant side effects of aminophylline were seen. Infants receiving aminophylline (n = 21) were less likely to have apnea (2 vs 11) or be intubated for apnea (0 vs 6). Length of postoperative stay and survival to discharge were similar between the 2 groups.


CONCLUSIONS
Aminophylline was effective for the prevention of apnea and intubation for apnea associated with PGE1 in infants with ductal-dependent congenital heart disease.
Lim
D S
DS
Department of Pediatrics, University of Virginia, Charlottesville, Virginia 22908-0386, USA. sl9pc@virginia.edu
Kulik
Thomas J
TJ
Kim
Dennis W
DW
Charpie
John R
JR
Crowley
Dennis C
DC
Maher
Kevin O
KO
D000527:Alprostadil / Q000009:adverse effects* / Q000627:therapeutic use; D000628:Aminophylline / Q000009:adverse effects / Q000627:therapeutic use*; D001049:Apnea / Q000517:prevention & control*; D001919:Bradycardia / Q000517:prevention & control; D001993:Bronchodilator Agents / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D004374:Ductus Arteriosus, Patent / Q000188:drug therapy*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects; D000860:Hypoxia / Q000517:prevention & control; D007231:Infant, Newborn; D007442:Intubation, Intratracheal; D007508:Irritable Mood / Q000187:drug effects; D007902:Length of Stay; D010166:Palliative Care; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
D001993:Bronchodilator Agents; D006993:Hypnotics and Sedatives; D000628:Aminophylline; D000527:Alprostadil