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Apnea of Prematurity

AOP


Presentation

  • Malformations of the brain or less likely, the spinal cord, should be considered in an otherwise healthy infant who presents with apnea at birth.[doi.org]
  • Both included studies were randomized double-blind placebo control prevention trials among babies CONCLUSION: Present evidence does not support the regular use of carnitine for the prevention of apnea of prematurity.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: Because theophylline was more effective in reducing the number and severity of apneas, inhalation of low concentration of CO(2), as used in the present study, cannot be considered as an alternative to theophylline in the treatment of apnea[ncbi.nlm.nih.gov]
  • Therefore, we conducted the present study in order to investigate the efficacy and harmful events of low-dose doxapram therapy for idiopathic AOP in very low-birth weight (VLBW) infants in a larger population.[ncbi.nlm.nih.gov]
  • Present study aimed to compare rate of mortality and survival with normal neurodevelopment outcome at 18 to 24 months of corrected age, between Caffeine- and Aminophylline-treated infants for apnea of prematurity.[ncbi.nlm.nih.gov]
Respiratory Abnormalities
  • Risk of cardio-respiratory abnormalities in preterm infants placed in car seats: a cross-sectional study. BMC Pediatr. 2005. 5:28. [Medline]. Pilley E, McGuire W.[emedicine.com]
Prolonged Expiration
  • Thereafter, they inhibit inspiration, prolong expiration, or both, while increasing lung volume. [22] Active shortening of expiratory duration with decreased lung volume may provide a breathing strategy for preserving FRC in a neonate with a highly compliant[emedicine.com]
Visual Impairment
  • Postnatal characteristics such as hearing and visual impairments during NICU stay were noted and same were followed up.[ncbi.nlm.nih.gov]
  • impairment, sensorineural deafness, varying degrees of mental retardation, and even death. 13 It is interesting to note, however, that AOP does not seem to be a future determinant of sudden infant death syndrome (SIDS). 9,14 Goals of Therapy The clinical[uspharmacist.com]
  • There were no infants with a hearing impairment in either group, and only one infant with visual impairment (doxapram group). Univariate analysis of infants with a MDI/PDI 2 ).[karger.com]
Dermatitis
  • Adverse events occurred in only one of 132 infants: erosive dermatitis developed on the nose after application of Re-NCPAP.[ncbi.nlm.nih.gov]
Indecisiveness
  • However, Clinicians show indecision in choosing the right agent for Apnea of Prematurity in most of the developing countries.[ncbi.nlm.nih.gov]

Workup

Bilirubin Increased
  • We hypothesized that in this population, as bilirubin increases and causes auditory brainstem dysfunction, respiratory control system may also be adversely affected leading to increased frequency of AoP.[ncbi.nlm.nih.gov]
Decreased Functional Residual Capacity
  • Paradoxical chest movement may predispose the baby to apnea by decreasing functional residual capacity (FRC) and limiting oxygenation. [22] Chemoreceptors and mechanoreceptors Complex relationships exist between respiratory control; several sites of central[emedicine.com]

Treatment

  • All causes of secondary apnea must be ruled out before initiating treatment for AOP. Treatment will depend on the etiology as well as effectiveness and tolerability of the treatment by the patient.[ncbi.nlm.nih.gov]
  • RESULTS: Thirty-seven neonates received theophylline (T) and 33 caffeine (C) for treatment (8 T/10 C) or prevention of apnea (29 T/23 C).[ncbi.nlm.nih.gov]
  • Key treatment issues include (1) lack of standardization for definition, diagnosis, and treatment of AOP, (2) unproven benefit of intervention, (3) lack of real-time data documenting AOP events, (4) unevaluated sustained treatment improvement at 7 days[ncbi.nlm.nih.gov]
  • Interestingly, xanthine treatment caused increased plasma beta-ED release when apneas decreased.[ncbi.nlm.nih.gov]
  • OBJECTIVE: To compare the effect of prolonged inhalation of a low concentration of CO(2) with theophylline for the treatment of apnea of prematurity.[ncbi.nlm.nih.gov]

Prognosis

  • […] metabolism* Hypoxia/complications Hypoxia/metabolism* Infant, Newborn Infant, Premature/metabolism Infant, Premature, Diseases*/etiology Infant, Premature, Diseases*/metabolism Infant, Premature, Diseases*/physiopathology Infant, Premature, Diseases*/therapy Prognosis[ncbi.nlm.nih.gov]
  • Because the prognosis is excellent and because the infant is not compromised, no treatment is usually required.[emedicine.com]

Etiology

  • Publication type, MeSH terms, Substances Publication type Review MeSH terms Apnea*/etiology Apnea*/metabolism Apnea*/physiopathology Apnea*/therapy Arrhythmias, Cardiac/chemically induced Brain Stem/drug effects Brain Stem/growth & development Caffeine[ncbi.nlm.nih.gov]
  • The pathophysiology of apnea is considered in detail, including the chemosensory and reflex input that modulates respiration and the involvement of upper airway control in the etiology of obstructive apnea.[ncbi.nlm.nih.gov]
  • In addition to the recognized etiologic factors for apnea of prematurity, this study suggests a role played by genetic factors.[ncbi.nlm.nih.gov]
  • Treatment will depend on the etiology as well as effectiveness and tolerability of the treatment by the patient.[ncbi.nlm.nih.gov]
  • Its etiology is often multi factorial and diagnosis of idiopathic forms requires exclusion of other underlying diseases.[jpnim.com]

Epidemiology

  • The definition and classification of apnea are discussed, as well as its epidemiology and natural history.[ncbi.nlm.nih.gov]
  • The purpose of this clinical report is to review the evidence basis for the definition, epidemiology, and treatment of apnea of prematurity as well as discharge recommendations for preterm infants diagnosed with recurrent apneic events.[ncbi.nlm.nih.gov]
  • The purpose of this clinical report is to review the evidence basis for the defi nition, epidemiology, and treatment of apnea of prematurity as well as discharge recommendations for preterm infants diagnosed with recurrent apneic events.[jhu.pure.elsevier.com]
  • Author information 1 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada. schmidt@mcmaster.ca Abstract CONTEXT: Very preterm infants are prone to apnea and have an increased risk of death or disability.[ncbi.nlm.nih.gov]
  • Epidemiology [ edit ] Apnea of prematurity occurs in at least 85 percent of infants who are born at less than 34 weeks of gestation.[en.wikipedia.org]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiology of apnea is considered in detail, including the chemosensory and reflex input that modulates respiration and the involvement of upper airway control in the etiology of obstructive apnea.[ncbi.nlm.nih.gov]
  • Future genomic studies may provide information on pathophysiological mechanisms that underlie AOP.[ncbi.nlm.nih.gov]
  • The physiology and pathophysiology behind AOP are discussed, including the laryngeal chemoreflex and sensitivity to inhibitory neurotransmitters, as are the mechanisms by which different therapies may work and the potential long-term neurodevelopmental[ncbi.nlm.nih.gov]
  • In this review we discuss the pathophysiology leading to the perfect storm, diagnostic assessment of breathing instability in this unique population and therapeutic interventions that aim to stabilize breathing without contributing to tissue injury.[ncbi.nlm.nih.gov]
  • However, in cases where toxicity is of concern or for neonates with congenital or pathophysiologic process that may alter the pharmacokinetics of these drugs, therapeutic drug monitoring may be warranted to monitor for methylxanthine toxicity.[ncbi.nlm.nih.gov]

Prevention

  • Both included studies were randomized double-blind placebo control prevention trials among babies CONCLUSION: Present evidence does not support the regular use of carnitine for the prevention of apnea of prematurity.[ncbi.nlm.nih.gov]
  • RESULTS: Thirty-seven neonates received theophylline (T) and 33 caffeine (C) for treatment (8 T/10 C) or prevention of apnea (29 T/23 C).[ncbi.nlm.nih.gov]
  • The drugs are equally effective in preventing apnea in the premature infant.[ncbi.nlm.nih.gov]
  • Nursing measures to prevent and manage apnea are reviewed with an emphasis on parent education and preparation for discharge.[ncbi.nlm.nih.gov]
  • Standard clinical management of the obstructive subtype of AOP includes prone positioning and continuous positive or nasal intermittent positive pressure ventilation to prevent pharyngeal collapse and alveolar atelectasis, while methylxanthine therapy[ncbi.nlm.nih.gov]

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