Prins S A, Pans S J A, van Weissenbruch M M, Walther F J, Simons S H P
Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, J6-S, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
Division of Neonatology, Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands.
Int J Pediatr. 2013;2013:251047. doi: 10.1155/2013/251047. Epub 2013 Nov 26.
Apnoea of prematurity is treated with noninvasive respiratory therapy and methylxanthines. For therapy unresponsive apnoea doxapram is often prescibed in preterm neonates. The duration, dosage and route of administration of doxapram together with its efficacy was evaluated in two Dutch neonatal intensive care. Outcome concerning short-term safety and neonatal morbidity were evaluated. During 5 years, 122 of 1,501 admitted newborns <32 weeks of gestational age received doxapram. 64.8% of patients did not need intubation after doxapram. 25% of treated neonates were <27 weeks of gestation. A positive response to doxapram therapy on apnoea was associated with longer duration of doxapram usage (P < 0.001), lower mean doses (P < 0.003), and less days of intensive care (median 33 versus 42 days; P < 0.002). No patients died during doxapram therapy. Incidence of necrotizing enterocolitis, intraventricular hemorrhage, periventricular leukomalacia, retinopathy of prematurity, persistent ductus arteriosus, or worsening of pulmonary condition did not increase during doxapram therapy. Doxapram is frequently used for apnoea of prematurity, despite a lack of data on short-term efficacy and long-term safety. Until efficacy and safety are confirmed in prospective trials, doxapram should be used with caution.
早产呼吸暂停采用无创呼吸治疗和甲基黄嘌呤进行治疗。对于治疗无反应的呼吸暂停，多沙普仑常用于早产新生儿。在两家荷兰新生儿重症监护病房评估了多沙普仑的给药持续时间、剂量、途径及其疗效。评估了短期安全性和新生儿发病率方面的结果。在5年期间，1501名孕周<32周的入院新生儿中有122名接受了多沙普仑治疗。64.8%的患者在使用多沙普仑后无需插管。25%接受治疗的新生儿孕周<27周。对多沙普仑治疗呼吸暂停的阳性反应与多沙普仑使用时间更长（P<0.001）、平均剂量更低（P<0.003）以及重症监护天数更少（中位数33天对42天；P<0.002）相关。在多沙普仑治疗期间无患者死亡。在多沙普仑治疗期间，坏死性小肠结肠炎、脑室内出血、脑室周围白质软化、早产儿视网膜病变、动脉导管未闭或肺部状况恶化的发生率并未增加。尽管缺乏关于短期疗效和长期安全性的数据，但多沙普仑仍经常用于早产呼吸暂停。在疗效和安全性在前瞻性试验中得到证实之前，应谨慎使用多沙普仑。
