Neonatal apnea, xanthines, and necrotizing enterocolitis*

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This study evaluates the relationship of xanthinetreatment of premature apnea and NEC in a bowel ischemia model. The superior mesenteric artery was occluded for 1.0 minute in 82 wheanling rats. Group I (n=41) were untreated controls. Group II (n=21) received aminophylline (AMPH) 40 mg/kg I.P., 4 hr and immediately prior to clamping. Animals were evaluated for bowel infarction, perforation, and mortality at 7 days. In 20 additional rats (10 @ group) bowel was evaluated by scanning electron microscopy (EM) at timed intervals (5 and 30 min). Ischemic bowel occurred in 25 of 41 (60%) controls (18 (43%) with necrosis; 7 (17%) with perforations) and 19 of 21 (90%) rats with AMPH (15 (70%) and had necrosis; 4 (19%) perforations). Mortality was 60% (controls) and 90% (AMPH) respectively (p<.05). On EM, AMPH enhanced bacterial overgrowth however actual mucosal damage appeared similar. Following ischemia, AMPH has an adverse effect on the bowel. Use of AMPH in prematures at risk for NEC is questioned.

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  • Evidence-Based Methylxanthine Use in the NICU

    2012, Clinics in Perinatology
    Citation Excerpt :

    Death may occur when extreme levels (>40 mg/L) are reached, often through accidental overdose. Reports of an increased risk of necrotizing enterocolitis with methylxanthine use in premature infants have also been observed.19 A subsequent report of 275 infants, however, from Davis and colleagues20 was unable to substantiate any increased clinical risk of theophylline in the development of necrotizing enterocolitis, and a large randomized trial (Caffeine for Apnea of Prematurity Trial) of 2006 infants by Schmidt and colleagues21 similarly failed to show any enhancing effect of caffeine on rates of necrotizing enterocolitis.

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*

Presented before the XXIX Annual Congress of the British Association of Paediatric Surgeons, Madrid, Spain, July 21–23, 1982.

1

From the Section of Pediatric Surgery, Department of Surgery and the Department of Pathology, Indiana University School of Medicine and the James Whitcomb Riley Hospital for Children, Indianapolis, Ind.

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