Anemia of Prematurity - Portal Neonatal

TREATMENT Section 6 of 11
Medical Care:
• Stimulation
o Tactile stimulation usually is sufficient to terminate an apneic event.
o Gently elevate the infant's jaw if the upper airway is obstructed.
• Oxygen administration
o Supplemental oxygen administration or bag-mask ventilation is indicated for infants
with signs of bradycardia or desaturation.
o Medical treatment is indicated when apneic episodes number 6-10 or more per day or
when the infant does not respond to tactile stimulation or requires bag-mask
ventilation.
• CPAP use
o CPAP has been used to treat apnea in preterm neonates, and it is indicated when the
infant continues to have apneic episodes despite a therapeutic methylxanthine serum
level.
o CPAP is delivered with nasal prongs, a nasal mask, or a face mask with 3-6 cm of
water pressure.
o CPAP is used to effectively treat mixed and obstructive apnea, but it has little or no
effect on central apnea. This limitation suggests that CPAP may reduce the frequency
of apnea by means of several mechanisms, including stabilization of PaO2 by
increasing the functional residual capacity (FRC), by altering the influence of stretch
receptors on respiratory timing, or by splinting the upper airway in an open position.
MEDICATION Section 7 of 11
Methylxanthine administration may help reduce the incidence of events in a child with central apnea,
although apnea in 15-20% of children does not respond to methylxanthines.
Home monitoring after discharge always is necessary for an infant whose apneic episodes continue
despite methylxanthine administration. Infants undergoing methylxanthine therapy should rarely be
sent home without a monitor because apnea may recur once they outgrow their therapeutic level.
Some families, however, cannot manage a monitor in the home, and, in these cases, caffeine
administration may be the only possible therapy. For more about follow-up care, see Follow-up Care.
Doxapram use should be reserved for infants in whom appropriate methylxanthine therapy and CPAP
fail to control severe apneic events.
Drug Category: Methylxanthines -- These appear to stimulate skeletal and diaphragmatic muscle
contraction, increase the ventilatory center's sensitivity to carbon dioxide, and stimulate the central
respiratory drive.