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APNEIC ATTACKS in the preterm infant have recently received widespread attention in the medical literature. Physiologists have presented new data regarding the pathogenesis of this disorder, and clinicians have proposed many new forms of therapy. Frequently, however, a new treatment regimen becomes incorporated into nursery routine without regard for alternative, perhaps less invasive, modes of treatment, and often without consideration of the cause of apnea. It is the purpose of this report to review recent concepts regarding the pathogenesis of neonatal apnea and to propose a treatment schema based on counteracting the supposed physiologic aberrations with a minimum of risk.

It has been suggested that idiopathic apnea of prematurity is related to hypoxia from pulmonary instability or an immaturity of central respiratory control mechanisms. To explore these hypotheses, 18 preterm infants were studied to examine the therapeutic effects of prophylactic cutaneous stimulation (6) and continuous positive airway pressure (12). The frequency of apnea using each procedure was reduced by 35 and 69%, respectively. These findings constitute the basis for new therapeutic measures for treatment of idiopathic neonatal apnea.

Growth, neurologic, and ophthalmologic assessments were done in 21 low-birth-weight infants given caffeine for neonatal apnea and in 21 matched control infants. Caffeine significantly decreased the need for and the duration of mechanical ventilation. No difference in growth and development was noted between the control and caffeine-treated infants. A high incidence of cicatricial retrolental fibroplasia was observed in both control (10/21) and caffeine-treated infants (7/18).