Table 47.2.

Therapies for apnoea of prematurity

Effective therapies for idiopathic apnoea	Comments
Physiological stimulation
Tactile stimulation	Used for minor apnoea
Air cushion	Infrequently used
Inhaled low-concentration CO2	Experimental (Abu-Shaweesh and Martin 2008)
Pharmacologic stimulation
Xanthines Caffeine used in recommendeddosing	Safe; serum concentration monitoring not needed; ↓ bronchopulmonary dysplasia and ↑ neurodevelopment ↓ Postoperative apnoea in former preterms up to ~60 postmenstrual weeks
Theophylline	Bronchodilator properties may be useful
Doxapram	In high dose ↑ seizures; rarely used
Respiratory support
Nasal cannulae: high flow	Alternative to NCPAP but applied pressure not monitored; used in weaning from NCPAP
Nasal CPAP	Mainstay of therapy; modern device available with low work of breathing Mixed apnoea > central apnoea
Non-invasive positive pressure ventilation	May be useful; more trials awaited
Invasive artificial ventilation	Final resort: has risks of ‘endotrauma’