Brain hemodynamic effects of doxapram in preterm infants.

BACKGROUND: Doxapram is a respiratory stimulant widely used for the treatment of idiopathic apnea of prematurity, although it has been demonstrated that it can induce a transient decrease of cerebral blood flow and that isolated mental delay in infants weighing <1,250 g is associated with the total dosage and duration of doxapram therapy.

OBJECTIVES: To evaluate the effects of doxapram on cerebral hemodynamics in preterm infants using cerebral Doppler ultrasonography and near-infrared spectroscopy.

METHODS: Preterm infants who required treatment with doxapram for apnea of prematurity unresponsive to caffeine were treated with doxapram at an hourly dose of 0.5 mg x kg(-1).h(-1), followed by 1.5 and 2.5 mg x kg(-1).h(-1).

RESULTS: 20 preterm infants were studied. Doxapram induced a significant decrease of oxygenated hemoglobin (O(2)Hb) and cerebral intravascular oxygenation (HbD = O(2)Hb - HHb) and an increase of HHb and CtOx concentrations, while cerebral blood volume and cerebral blood flow velocity did not change.

CONCLUSIONS: Doxapram infusion induces the increase of cerebral oxygen consumption and requirement and the contemporary decrease of oxygen delivery probably mediated by a decrease of cerebral blood flow. Caution must be recommended in prescribing this drug for apnea of prematurity.