Anet Papazovska CherepnalkovskiUniversity of Split, Croatia
Title: Apnea of prematurity, from cause to treatment with caffeine citrate
Apnea of prematurity (AOP) is considered one of the most common diagnoses in neonatal intensive care units. Vanishing of apnea is usually a prerequisite for discharge planning. Apneas make significant contribution to the length of hospital stay of premature infants. AOP is by definition a prolonged respiratory pause (?20 seconds) or a shorter breathing pause followed by bradycardia. Three types of apneas have been recognized among which most common are mixed apneas. The incidence of apnea is inversely proportional to gestational age, thus almost all preterm infants ?28 weeks have episodes of apnea, as evidenced by monitoring. Above 28 weeks, the frequency decreases, from around 85% at 30 weeks to 20% at 34 weeks. Apnea often persists beyond term gestation in newborns born 24-28 weeks. Preterm infants have an increased risk of SIDS; however, the data do not support a causal relationship with preterm apnea. Various treatment modalities are explored for AOP ranging from prone positioning, application of nasal CPAP, methylxanthine therapies to certain novel and less explored therapeutic measures such as tactile and olfactory stimulation, transpyloric feeding and kangaroo care as well as doxapram treatment. Among the methylxanthines, caffeine has been associated with better long-term outcomes. During the talk, our departments polices and experiences with medication and other treatment options for apneas will be presented. Some controversial issues will be addressed such as: blood transfusion and apnea relationship, the role of gastroesophageal reflux and the effects of apnea on neurodevelopment. In conclusion, apnea of prematurity reflects the immaturity of respiratory control. Newborns born at ?28 weeks may show apneas that last until or after term age. Caffeine citrate given at standard doses is a safe and effective medication for the treatment of preterm apnea. Prolonged apnea monitoring can be expected in extremely immature preterm infants.
Anet Papazovska Cherepnalkovski has completed her PhD at the University of Skopje, Republic of North Macedonia in 2016. She has worked as Head of Department for preterm birth from 2013-2015 and Head of Clinical Department of neonatology at the Pediatric Clinic in Skopje, before transferring to work as an intensive care neonatologist at University Hospital of Split, Croatia. She has been involved in education of medical students and pediatric residents since 2008 both in N. Macedonia and Croatia and promoted into assistant professor in 2020. She has been assigned head of three and associate on one undergraduate courses at the Department for midwifery. She has over 90 publications, and her publication h-index is 2. She has been lecturing two continuous medical education courses in Croatia and one CME course in N. Macedonia. She has collaborated on 3 scientific research projects and has been serving as an editorial board member of several reputed journals.