Management of apnea in infants.

The incidence and proposed mechanisms of apnea of infancy and apnea of prematurity are briefly reviewed, and the use of methylxanthines in managing these conditions is discussed. Apnea may result from incomplete neurological development of the infant. A sleep-related defect in respiratory control mechanisms has been proposed. Apnea may be secondary to physiologic abnormalities that cause airway obstruction or to cardiac disease or arrhythmia, seizure disorders, infection, or other disorders. Therapy often includes supportive management. The primary pharmacologic agents used to treat apnea of prematurity are caffeine and theophylline. The metabolism of these drugs differs greatly between newborns and adults and changes rapidly in the first nine months of life; in infants up to 4 1/2 months of age, the half-life of these compounds is prolonged. While only theophylline is approved in the United States for management of apnea, caffeine has several potential advantages. However, no suitable caffeine product is available. The accepted pharmacologic treatment for apnea of prematurity is the use of the methylxanthines theophylline and caffeine. Theophylline has also been used in treating apnea of infancy, although there are fewer data documenting its efficacy for this indication.