For those infants <60 weeks PMA, apnea is a significant risk in the 24 hours after an
anesthetic.
Treatment for apnea
- Xanthines such as caffeine, aminophylline and theophylline are central stimulants
that may improve diaphragmatic contraction and inhibit hypoxia-induced ventilation.
Caffeine citrate (IV or enteral has a loading dose of 20 mg/kg and maintenance of 5- 8
mg/kg q 24 hrs). Theophylline (po) and aminophylline (IV) has a loading 5 mg/kg, with a
maintenance of 1.2-2mg/kg/dose every 6-8 hrs. - Additional therapy may include the use of nasal CPAP, which splints upper airway
with positive pressure and stimulates breathing with increased flow. CPAP may
stabilize Functional Residual Capacity. NCPAP is started at 5 - 8 cm water pressure
(maximum of 10-12 cm water). It may exacerbate reflux.
ANEMIA OF PREMATURITY
At birth, the hematocrit ranges ~40-60% For term babies, hemoglobin, declines to ~9
g/dl by 10 wks. In premature infants, Hgb declines to ~7-8 g/dl by 7 - 8 wks. Physiologic
anemia of prematurity is often long-term and not necessarily pathologic. Neonatal red
cells have short life spans and stressed marrow may exacerbate anemia.