title: [Determinants of doxapram utilization: a survey of practice in the French Neonatal and Intensive Care Units].
abstract: Methylxanthines and doxapram have been used to stimulate breathing and to prevent apnea in preterm infants. The use of doxapram is controversial because the therapeutic index seems to be narrow and short-term adverse effects have been described.
  
  
  OBJECTIVE
  To determine the use of doxapram in the French neonatal and intensive care units.
  
  
  METHODS
  A structured postal questionnaire was sent to all the 236 neonatology and neonatal intensive care units of level IIa, IIb and III in France. The questionnaires were analysed after four months.
  
  
  RESULTS
  Answers were obtained from 159 chiefs of department (67.4%), 102 used doxapram (64.1%). Doxapram was mainly used as a second step, if methylxanthines failed to reduce the frequency of apneic spells (102/159 units, 64.1%). Doxapram was usually administered intravenously (91/102 units, 89.2%). Only 57 respondents (35.8%) did not use doxapram, because they were aware of the potential adverse effects or they did not know the drug. Monitoring of drug plasma concentrations was rarely performed (11/102 services, 10.8%). Nevertheless, there was a significant interest in this monitoring.
  
  
  CONCLUSIONS
  Doxapram is frequently used in France to reduce apnea of prematurity if methylxanthine therapy fails. Further studies are needed to determine safety of doxapram at short and long-term. A multicenter, randomised, double-blinded clinical trial would be interesting to perform, similar to the ongoing caffeine for Apnoea of Prematurity trial (CAP) . The French setting seems appropriate for this kind of study.
authors.affiliation: Unité de néonatologie, hôpital des enfants, 330 avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France.
authors.forename: M
authors.initials: M
authors.lastname: Bénard
authors.forename: M J
authors.initials: MJ
authors.lastname: Boutroy
authors.forename: I
authors.initials: I
authors.lastname: Glorieux
authors.forename: C
authors.initials: C
authors.lastname: Casper
mesh_terms: D001049:Apnea / Q000188:drug therapy; D004315:Doxapram / Q000627:therapeutic use*; D005602:France; D019538:Health Care Surveys; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D019141:Respiratory System Agents / Q000627:therapeutic use*
chemical_list: D019141:Respiratory System Agents; D004315:Doxapram