Methylxanthine therapy in premature infants: Sound practice, disaster, or fruitless byway?☆,☆☆
Section snippets
“Neonatal Apnea, Bradycardia, or Desaturation: Does It Matter?”
Martin and Fanaroff4 chose this provocative title for a recent editorial in The Journal. These authors concluded that “the clinical significance and long-term consequences of persistent apnea, bradycardia, or desaturation remain a subject of considerable debate.”4 Although it is reasonable to be concerned about episodes that cause prolonged anoxia and acidosis, such events are unlikely to occur as a result of apnea of prematurity in the closely monitored environment of modern neonatal intensive
Randomized Controlled Trials of Methylxanthine Therapy in Preterm Infants: Small Numbers and Short Duration of Follow-up
The efficacy of methylxanthine treatment for apnea in preterm infants has been the subject of 4 recent systematic reviews of randomized clinical trials for the international Cochrane Collaboration. Infants in the control groups of those trials were randomized to the following alternatives: (1) placebo or no treatment,18 (2) doxapram,19 (3) continuous positive airway pressure,20 and (4) kinesthetic stimulation.21 Two additional Cochrane review groups examined prophylactic methylxanthine for
Should We Be Concerned About the Safety of Methylxanthine Therapy in Premature Infants?
Methylxanthines are antagonists of adenosine A1 and A2a receptors at “therapeutic” plasma concentrations.26, 27 Adenosine is neuroprotective during ischemia; acute administration of a methylxanthine exacerbates ischemic brain damage.28
Over the past 20 years, several investigators have warned of the potential for deleterious effects of methylxanthines during acute neonatal hypoxemia and ischemia.29, 30, 31 The experiments by Thurston et al29 are especially of concern: 3- to 9-day-old mice were
Acknowledgements
I am grateful to Drs Edmund Hey, William Silverman, and John C. Sinclair for their encouragement and advice.
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