Interventions for apnoea of prematurity: a personal view.
OBJECTIVE
To review treatments for apnoea of prematurity (AOP).


METHODS
Literature Review and description of personal practice.


RESULTS
Provided that symptomatic apnoea has been ruled out, interventions to improve AOP can be viewed as directed at one of three underlying mechanisms: (i) a reduced work of breathing [e.g. prone positioning, nasal continuous positive airway pressure (CPAP)], (ii) an increased respiratory drive (e.g. caffeine), and (iii) an improved diaphragmatic function (e.g. branched-chain amino acids). Most options currently applied, however, have not yet been shown to be effective and/or safe, except for prone, head-elevated positioning, synchronized nasal ventilation/CPAP, and caffeine.


CONCLUSIONS
Treatment usually follows an incremental approach, starting with positioning, followed by caffeine (which should be started early, at least in infants <1250 g), and nasal ventilation or CPAP via variable flow systems that reduce work of breathing. From a research point of view, we most urgently need data on the frequency and severity of bradycardia and intermittent hypoxia that can yet be tolerated without putting an infant at risk of impaired development or retinopathy of prematurity.
Poets
C F
CF
Department of Neonatology, Tübingen University Hospital, Tübingen, Germany. Christian-f.poets@med.uni-tuebingen.de
D000596:Amino Acids / Q000008:administration & dosage; D001049:Apnea / Q000628:therapy*; D002110:Caffeine / Q000627:therapeutic use; D045422:Continuous Positive Airway Pressure; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000628:therapy*; D010102:Oxygen Inhalation Therapy; D011187:Posture
D000596:Amino Acids; D002110:Caffeine