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PEDIATRICS Vol. 112 No. 1 July 2003, pp. e27-e29

ELECTRONIC ARTICLE

Aminophylline for the Prevention of Apnea During Prostaglandin E1 Infusion

D.S. Lim, MD*, Thomas J. Kulik, MD{ddagger}, Dennis W. Kim, MD, PhD{ddagger}, John R. Charpie, MD, PhD{ddagger}, Dennis C. Crowley, MD{ddagger} and Kevin O. Maher, MD§

* Department of Pediatrics, University of Virginia, Charlottesville, Virginia
{ddagger} Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
§ Department of Pediatrics, University of Connecticut, Hartford, Connecticut

Background. Apnea is associated with prostaglandin E1 infusion (PGE1) used in the palliation of ductal-dependent congenital heart lesions.

Hypothesis. Aminophylline is a central respiratory stimulant and will decrease the incidence of PGE1-associated apnea and the need for intubation for apnea in infants with ductal-dependent congenital heart disease.

Methods. Informed consent was obtained for all patients. In a prospective, double-blinded, placebo-controlled study, newborn infants with ductal-dependent congenital heart disease were randomized to receive either aminophylline or placebo during initiation and maintenance of PGE1, which was started at 0.01 µg/kg/min and increased to 0.03 µg/kg/min. Aminophylline was given as a bolus dose of 6 mg/kg before or during initiation of PGE1, and continued at 2 mg/kg dose every 8 hours for 72 hours. Serum aminophylline levels were checked at 18 and 36 hours. The primary study endpoint was intubation for apnea, with a secondary endpoint of apnea, as defined as acute cessation of breathing with associated hypoxia and bradycardia.

Results. The study evaluated 42 infants. The 2 groups were similar for gestational age, weight, hematocrit, and use of sedation. In the aminophylline group, serum levels were 7.6 ± 1.2 µg/mL. No significant side effects of aminophylline were seen. Infants receiving aminophylline (n = 21) were less likely to have apnea (2 vs 11) or be intubated for apnea (0 vs 6). Length of postoperative stay and survival to discharge were similar between the 2 groups.

Conclusions. Aminophylline was effective for the prevention of apnea and intubation for apnea associated with PGE1 in infants with ductal-dependent congenital heart disease.

Key Words: prostaglandin • apnea • congenital heart disease

Abbreviations: PGE1, prostaglandin E1 (infusion)

Received for publication Oct 18, 2002; Accepted Feb 13, 2003.




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