CO2 may be a better treatment for AOP

[hehady]

Dear 99nicu friends

Please give your comments on this pioneer study.

J Pediatr. 2008 Jun 3. [Epub ahead of print]

A Randomized Controlled Trial of Theophylline Versus CO(2) Inhalation for

Treating Apnea of Prematurity.

Al-Saif S, Alvaro R, Manfreda J, Kwiatkowski K, Cates D, Qurashi M, Rigatto H.

Departments of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada.

OBJECTIVE: To determine whether inhalation of 0.8% CO(2) in preterm infants

decreases the duration and rate of apnea as effectively as or better than

theophylline with fewer adverse side effects. STUDY DESIGN: A prospective,

randomized, control study of 42 preterm infants of gestational age 27 to 32 weeks assigned to receive inhaled CO(2) (n = 21) or theophylline (n = 21). The study group had a mean (+/- standard error of the mean) birth weight of 1437 +/- 57 g, gestational age of 29.4 +/- 0.3 weeks, and postnatal age of 43 +/- 4 days. After a control period, 0.8% CO(2) or theophylline was given for 2 hours, followed by a recovery period. RESULTS: In the CO(2) group, apneic time and rate decreased significantly, from 9.4 +/- 1.6 seconds/minute and 94 +/- 15 apneic episodes/hour to 3.0 +/- 0.5 seconds/minute and 34 +/- 5 apneic episodes/hour. In the

theophylline group, apneic time and rate decreased significantly, from 8 +/- 1

seconds/minute and 80 +/- 8 apneic episodes/hour to 2.5 +/- 0.4 seconds/minute and 28 +/- 3 apneic episodes/hour. Cerebral blood flow velocity (CBFV) decreased only during theophylline administration. CONCLUSIONS: Our findings suggest that inhaled low (0.8%) CO(2) concentrations in preterm infants is at least as effective as theophylline in decreasing the duration and number of apneic episodes, has fewer side effects, and causes no changes in CBFV. We speculate that CO(2) may be a better treatment for apnea of prematurity than methylxanthines.

[ammar]

Thank you Hady

I think that the idea is very good and original. but i have some interrogations about

why the use of theophylline as control group

the total number of patient is little

the outcome included in the study period (time) is very short

the difference (statistics) is very little and perhaps not exist if number of patient was slightly higher than 42 preterms.

[drjha04]

Its promising and exciting but at present time its in stage of conception. First time i heard of it is in 2006 SPR meeting .If i remember correctly the fellow who presented the paper was from Boston children hospital.

[alsufayan]

Well...theophylline is widely used in NICUs cross the contenets ..

using theophylline as a control group would be reasonable , because this will more or

less reflect the reality of what happens in the majority of NICU populations

RGDS