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.

Agent Dose Plasma Concentration (mcg/ml) Toxicity
Caffeine citrate 20 mg/kg IV/PO followed by 5 mg/kg/day may need up to 7.5 mg/kg/d 5-20 > 50 mcg/ml (see Theophylline)
*Theophylline 5 mg/kg IV followed by 2 mg/kg q 8 - 12 h 5 - 15 > 20 mcg/ml Irritability, tachycardia, arrhythmia, seizures
Doxapram1 1 - 2 mg/kg/h IV
12 - 24 mg/kg q 6 h PO
1-2 > 5 mcg/ml Hypertension, feeding intolerance, seizures. Contains benzyl alcohol

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.