Carnitine supplementation for preterm infants with recurrent apnoea

More research is needed before the use of carnitine for the treatment of apnoea of prematurity can be recommended in clinical practice.

Apnea of prematurity is a common problem in preterm infants in the neonatal intensive care setting (NICU). Recurrent apnoea episodes are correlated with adverse neurological development in this population. Carnitine deficiency has been shown to be associated with apnoea and respiratory failure in infants and in adults. The review authors investigated whether treatment of premature babies with carnitine will help in the reduction or resolution of apnoea episodes, and the need for ventilation. No treatment trials were identified.


Authors' conclusions: 

Despite the plausible rationale for the treatment of apnoea of prematurity with carnitine, there are insufficient data to support its use for this indication. Further studies are needed to determine the role of this treatment in clinical practice.

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Background: 

Apnea of prematurity is a common problem in preterm infants in the neonatal intensive care setting (NICU) often delaying their discharge home or transfer to a step down unit. Premature infants are at increased risk of carnitine deficiency. Carnitine supplementation has been used for both prevention and treatment of apnoea.

Objectives: 

To determine whether treatment with carnitine will reduce the frequency of apnoea, the duration of ventilation and the duration of hospital stay in preterm infants with recurrent apnoea.

Search strategy: 

Computerised searches were carried out independently by two reviewer authors. We searched MEDLINE (1966 to December 2010), EMBASE (1988 to December 2010), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2010), abstracts of annual meetings of the Society for Pediatric Research (1995 to 2010), and contacts were made with the subject experts.

Selection criteria: 

Only randomised or quasi-randomised treatment trials of preterm infants with a diagnosis of recurrent apnoea of prematurity were considered. Trials were included if they involved treatment with carnitine compared to placebo or no treatment, and measured at least one of the following outcomes: failure of resolution of apneas, the duration of ventilation and the duration of hospital stay.

Data collection and analysis: 

Two reviewer authors evaluated the papers for inclusion criteria and quality. Corresponding authors were contacted for further information where needed.

Main results: 

No eligible trials were identified.

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