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Iowa Neonatology Handbook: Pharmacology
Apnea in Newborns
Jeffrey L. Segar, MD
Peer Review Status: Internally Peer Reviewed
The cause of apnea should be thoroughly investigated (see
Pulmonary section). Only if no treatable cause can be found, the
diagnosis of apnea of prematurity can be considered (diagnosis of
exclusion). If necessary, central apnea of prematurity may be treated
using one of the following drugs.
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Agent
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Dose
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Plasma Concentration (mcg/ml)
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Toxicity
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Caffeine citrate
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20 mg/kg IV/PO followed by 5 mg/kg/day may need up to 7.5
mg/kg/d
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5 - 20
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> 50 mcg/ml (see Theophylline)
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*Theophylline
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5 mg/kg IV followed by 2 mg/kg q 8 - 12 h
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5 - 15
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> 20 mcg/ml Irritability, tachycardia, arrhythmia,
seizures
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Doxapram1
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1 - 2 mg/kg/h IV
12 - 24 mg/kg q 6 h PO
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1 - 2
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> 5 mcg/ml Hypertension, feeding intolerance,
seizures. Contains benzyl alcohol
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1 Further studies needed on bioavailability, toxicity, and long
term efficacy. Potential toxicity with vehicle which contains benzyl
alcohol. The drug of choice caffeine. If apnea persists despite
appropriate doses, doxapram may replace caffeine. If response is
still inadequate, both drugs may be combined.
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