1. Initiation of Methylxanthines
2. When to go to Trial
3. Assisted Ventilation

Definition of Apneic Event by Type of Intervention		Treatment Indication
No Intervention Required		frequent episodes associated with desaturations (SaO2<80) and/or bradycardia (HR<80); e.g., one or more per hour over a long period of time such as 12-24 hours
Mild	light touch, stroke back associated with desaturations <80 & bradycardia <90	multiple episodes; more than 6 over a 12 hr period or 12 over a 24 hr period
Moderate	move infant, i.e. roll over, re-position, etc. O2 administered	more than 2 episodes in a 24 hr period
Severe	prolonged vigorous stimulus PPV with or without O2	more than 1 episode in a 24 hr period

 

Note
ABCs associated with feeding, handling, suctioning, mucus plugging, etc. should not be counted when determining whether to initiate methylxanthine treatment.

Treatment Recommendation

Preparation: caffeine citrate 20 mg/ml both IV & PO (PO only at CHMC) (20 mg of caffeine citrate = 10 mg of caffeine base)

Load IV & PO: 20 mg/kg of citrate (=10 mg/kg of base)

Maintenance IV & PO: 5-7.5 mg/kg QD of citrate (=2.5-3.75 mg of base)

Acceptable: serum level could range from a low of 5 to an upper limit of 20, depending on patient response

Apnea that continues in spite of optimum methylxanthine treatment may respond to low level CPAP. Accordingly, a trial of CPAP (4-6 cm. of water) is warranted in addition to or as an alternative to ineffective methylxanthine treatment.

Frequent apnea associated with marked bradycardia and/or desaturations refractory to methylxanthines and/or CPAP should be treated with positive pressure ventilation.

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