Kinesthetic stimulation versus theophylline for apnea in preterm infants

There is some evidence that theophylline may be more effective for apnea in preterm babies than kinesthetic stimulation, but more research is needed.

Apnea is a pause in breathing of greater than 20 seconds. It may occur repeatedly in preterm babies (born before 34 weeks). Immaturity alone can cause apnea, but so can infections. Apnea may be harmful to the developing brain or organs if it continues. Various methods have been tried to reduce apnea in premature babies including drugs, physical stimulation by nurses and kinesthetic stimulation (using an oscillating mattress which moves from side to side). The review of trials found some evidence that the drug theophylline may be more effective than kinesthetic stimulation for apnea but more research is needed.

Authors' conclusions: 

The results of this review should be treated with caution. Theophylline has been shown in one small study to be superior to kinesthetic stimulation at treating clinically important apnea of prematurity. There are currently no clear research questions regarding the comparison of methylxanthines and kinesthetic stimulation to treat apnea of prematurity.

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Background: 

Apnea of prematurity may lead to hypoxemia and bradycardia requiring resuscitative measures being instituted. Many treatments have been used in infants with apnea of prematurity including methylxanthines. Physical stimulation is often used to restart breathing and it is possible that repeated stimulation such as with an oscillating mattress or other kinesthetic stimulation, might also be used to treat infants with apnea and prevent its consequences.

Objectives: 

To determine if kinesthetic stimulation is more effective than a methylxanthine in preventing clinically important apnea in preterm infants with apnea.

Search strategy: 

The standard search strategy of the Cochrane Neonatal Review Group was used. This included searches of the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2009), the Oxford Database of Perinatal Trials, MEDLINE, PREMEDLINE, CINAHL and EMBASE in October 2009. Searches were performed of previous reviews including cross references, abstracts, conferences, symposia proceedings, expert informants, and journal handsearches mainly in the English language.

Selection criteria: 

All trials using random or quasi-random patient allocation in which kinesthetic stimulation was compared to methylxanthine therapy for apnea of prematurity were eligible.

Data collection and analysis: 

Standard methods of the Cochrane Collaboration and its Neonatal Review Group were used with separate evaluation of trial quality, data extraction by both authors and synthesis of data using relative risk and weighted mean difference. Measures of severity of apnea as well as the response to treatment were consistent with an evaluation of 'clinical apnea' as defined by the American Academy of Pediatrics.

Main results: 

A single study of 20 infants (Saigal 1986) demonstrated a significant benefit to the infants receiving theophylline compared to those on an oscillating water bed (OWB) in terms of mean rates of clinically important apnea (apnea > 14 seconds associated with bradycardia < 100 or cyanosis or receiving stimulation). There were no significant differences in adverse effects (death, sleep states, the Albert Einstein Neurobehavioral Index, adverse neurological outcomes, and the Bayley Mental Development Index at six and 12 months) although the infants on the OWB had a higher psychomotor index at six but not 12 months.

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