CO2 Inhalation as a Treatment for Apnea of Prematurity: A Randomized Double-Blind Controlled Trial

Alvaro, Ruben E.; Khalil, Mohammad; Qurashi, Mansour; Al-Saif, Saif; Al-Matary, Abdulrahman; Chiu, Aaron; Minski, John; Manfreda, Juri; Kwiatkowski, Kim; Cates, Don; Rigatto, Henrique

doi:10.1016/j.jpeds.2011.07.049

« Previous Next »The Journal of Pediatrics
Volume 160, Issue 2 , Pages 252-257.e1, February 2012

CO₂ Inhalation as a Treatment for Apnea of Prematurity: A Randomized Double-Blind Controlled Trial

Ruben E. Alvaro, MD
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
- Reprint requests: Dr Ruben E. Alvaro, University of Manitoba, Department of Pediatrics, WR004 Women’s Hospital, 735 Notre Dame Ave, Winnipeg, MB R3E 0L8 Canada.
Mohammad Khalil, MD
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
Mansour Qurashi, MD
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
Saif Al-Saif, MD
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
Abdulrahman Al-Matary, MD
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
Aaron Chiu, MD
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
John Minski, RRT
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
Juri Manfreda, MD
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
Kim Kwiatkowski, RN
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
Don Cates, BSc
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
Henrique Rigatto, MD
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada

Received 11 February 2011; received in revised form 14 June 2011; accepted 28 July 2011. published online 12 September 2011.

Objective

To compare the effect of prolonged inhalation of a low concentration of CO₂ with theophylline for the treatment of apnea of prematurity.

Study design

Prospective, randomized, double-blind controlled trial of 87 preterm infants with apnea of prematurity (27-32 weeks’ gestational age) assigned to either theophylline plus 0.5 L/min of room air via nasal prongs or placebo plus 0.5 L/min with CO₂ (about 1% inhaled) by nasal prongs for 3 days.

Results

Apnea time significantly decreased in the theophylline group from 189±33 s/h (control) to 57±11, 50±9, and 61±13 (days 1-3) (P=.0001) and in the CO₂ group from 183±44 (control) to 101±26, 105±29, and 94±26 s/h (days 1-3) (P=.03). Seven infants in the CO₂ group but none in the theophylline group failed to complete the study due to severe apneas (P=.003).

Conclusions

Because theophylline was more effective in reducing the number and severity of apneas, inhalation of low concentration of CO₂, as used in the present study, cannot be considered as an alternative to theophylline in the treatment of apnea of prematurity. The less effectiveness of CO₂ treatment may have been related to the variability of the delivery of CO₂.

bpm, Beats per minute, CAP, Caffeine for Apnea of Prematurity, CPAP, Continuous positive airway pressure, HR, Heart rate, SaO₂, Oxygen saturation, TcPco₂, Transcutaneous CO₂

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Supported by the Canadian Institutes of Health Research and The Children’s Hospital Foundation of Manitoba, Inc. The authors declare no conflicts of interest.

PII: S0022-3476(11)00778-5

doi:10.1016/j.jpeds.2011.07.049

« Previous Next »The Journal of Pediatrics
Volume 160, Issue 2 , Pages 252-257.e1, February 2012

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