PEDIATRICS Vol. 80 No. 5 November 1987, pp. 684-688
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Theophylline Treatment in the Extubation of Infants Weighing Less Than 1,250 Grams: A Controlled Trial

David J. Durand MD1, Ami Goodman MD1, Patricio Ray MD1, Roberta A. Ballard MD1, and Ronald I. Clyman MD1

1 From the Division of Neonatology, Mt Zion Hospital and Medical Center, San Francisco

The role of theophylline in weaning infants weighing less than 1,250 g at birth from mechanical ventilation was evaluated. Infants were randomized into control or theophylline treatment groups when they required minimal ventilatory support (peak inspiratory pressure 12 cm H2O, positive end-expiratory pressure 2 cm H2O, rate 12 breaths per minute, and FiO2 < 0.3), and they were extubated 24 hours later. Infants required reintubation if they had (1) Paco2 > 55 mm Hg and pH < 7.20, (2) FiO2 > 0.5, or (3) apnea associated with a heart rate less than 100 beats per minute that required frequent stimulation (more than 20 episodes during a 16-hour period). Among 32 infants (birth weight <1,000 g) who reached minimal ventilatory support before seven days after delivery, 13 of 18 (72%) control infants required reintubation, whereas only four of 14 (28%) theophylline-treated infants required reintubation. On the other hand, among infants (birth weight <1,000 g) who reached minimal ventilatory support after seven days following delivery, only one of six (17%) of the control group required reintubation and no improvement could be seen with theophylline treatment. Similarly, among control infants (birth weight 1,001 to 1,250 g), only ten of 45 (23%) required reintubation after reaching low intermittent manditory ventilation settings. In summary, most infants recovering from respiratory distress syndrome who had birth weights (1) >1,000 g or (2) <1,000 g and who were older than seven days could be successfully extubated from minimal ventilatory support without theophylline treatment. In contrast, most infants with birth weights <1,000 g who reached minimal ventilatory support within seven days after delivery required reintubation; treatment with theophylline significantly improved the ability of this group to remain extubated.

Key Words: theophylline • mechanical ventilation • respiratory distress syndrome • premature infant

Accepted on February 2, 1987




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