Apnea of prematurity: pathogenesis and management strategies.
Apnea of prematurity (AOP) is a significant clinical problem manifested by an unstable respiratory rhythm reflecting the immaturity of respiratory control systems. This review will address the pathogenesis of and treatment strategies for AOP. Although the neuronal mechanisms leading to apnea are still not well understood, recent decades have provided better insight into the generation of the respiratory rhythm and its modulation in the neonate. Ventilatory responses to hypoxia and hypercarbia are impaired and inhibitory reflexes are exaggerated in the neonate. These unique vulnerabilities predispose the neonate to the development of apnea. Treatment strategies attempt to stabilize the respiratory rhythm. Caffeine remains the primary pharmacological treatment modality and is presumed to work through blockade of adenosine receptors A(1) and A(2). Recent evidences suggest that A(2A) receptors may have a greater role than previously thought. AOP typically resolves with maturation suggesting increased myelination of the brainstem.
Section of Neonatology, Department of Pediatrics, Medical College of Georgia, Augusta, GA 30912-3740, USA. omathew@mail.mcg.edu
O P
OP
Mathew
D001049:Apnea / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy; D001145:Arrhythmias, Cardiac / Q000139:chemically induced; D001933:Brain Stem / Q000187:drug effects / Q000254:growth & development; D002110:Caffeine / Q000627:therapeutic use*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D045422:Continuous Positive Airway Pressure; D005325:Fetal Organ Maturity; D006801:Humans; D006935:Hypercapnia / Q000150:complications / Q000378:metabolism*; D000860:Hypoxia / Q000150:complications / Q000378:metabolism*; D007231:Infant, Newborn; D007234:Infant, Premature / Q000378:metabolism; D007235:Infant, Premature, Diseases / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy; D011379:Prognosis; D018047:Receptors, Purinergic P1 / Q000378:metabolism; D056152:Respiratory Rate / Q000187:drug effects*; D012137:Respiratory System / Q000187:drug effects / Q000254:growth & development
D000697:Central Nervous System Stimulants; D018047:Receptors, Purinergic P1; D002110:Caffeine