Management of apnoea in extremely preterm infants - a European Survey

Anna Lavizzari; G Jeroen Hutten; Christian Heiring; Moniek van de Loo; Wes Onland; Almudena Alonso-Ojembarrena; Harald Ehrhardt; Merih Cetinkaya; Tomasz Szczapa; Victor Sartorius; Gustavo Rocha; Martin Wald; Hanna Soukka; Olivier Danhaive; Theodore Dassios; Manuela Camelia Cucerea; Andrea Calkovska; Gabriel Dimitriou; Bernard Barzilay; Boris Filipovic-Grcic; Roland Hentschel; Ulrich H Thome; Kajsa Bohlin; Gianluca Lista; Sven Schulzke; Richard Plavka; Rasa Tameliene; Colm Patrick Finbarr O Apos Donnell; Anton H van Kaam; Richard Sindelar; Claus Klingenberg; ESPR Pulmonary Research Consortium

doi:10.1159/000547546

Management of apnoea in extremely preterm infants - a European Survey

Anna Lavizzari^*, G Jeroen Hutten, Christian Heiring, Moniek van de Loo, Wes Onland, Almudena Alonso-Ojembarrena, Harald Ehrhardt, Merih Cetinkaya, Tomasz Szczapa, Victor Sartorius, Gustavo Rocha, Martin Wald, Hanna Soukka, Olivier Danhaive, Theodore Dassios, Manuela Camelia Cucerea, Andrea Calkovska, Gabriel Dimitriou, Bernard Barzilay, Boris Filipovic-GrcicRoland Hentschel, Ulrich H Thome, Kajsa Bohlin, Gianluca Lista, Sven Schulzke, Richard Plavka, Rasa Tameliene, Colm Patrick Finbarr O Apos Donnell, Anton H van Kaam, Richard Sindelar, Claus Klingenberg, ESPR Pulmonary Research Consortium

^*Corresponding author af dette arbejde

Afdeling for Intensiv behandling af nyfødte og mindre børn JMC

Abstract

INTRODUCTION: Episodes of apnoea are common in extremely preterm infants (EPIs) and usually treated with caffeine and respiratory support. Understanding differences in apnoea definitions, monitoring practices, and use of respiratory stimulants is essential to improve future treatment.

METHODS: Between March and July 2024, one lead consultant at European tertiary neonatal intensive care units (NICUs) was invited to complete a web-based survey on respiratory practices in EPIs. We sought information how they defined apnoea and monitored for it, and how they treated it with caffeine, doxapram, and non-invasive respiratory support.

RESULTS: We received replies from 447/721 (62%) NICUs across 24 European countries. Most NICUs (74%) use both electrocardiogram electrodes and pulse oximetry for apnoea monitoring. All NICUs reported using caffeine citrate, with 102 centres (23%) starting it in the delivery room. The median loading, maintenance and maximum maintenance doses used are 20 mg/kg, 5 and 10 mg/kg/day, respectively. Caffeine is occasionally given twice daily in some NICUs (30%) and stopped at 34-35 weeks of postmenstrual age at most of them (74%). Doxapram is used at 111 (25%) NICUs, with geographical differences. Strategies for the use and escalation of non-invasive respiratory support in case of persistent apnoea are not clearly defined. Automatic closed-loop oxygen delivery is used at 25% of NICUs.

CONCLUSION: Despite consistency in the dosing and weaning of caffeine, there is much variation in the management of apnoea in preterm infants across Europe. Future research should focus on timing and dosage of caffeine, the use of doxapram, and strategies for optimising non-invasive respiratory support.

Originalsprog	Engelsk
Tidsskrift	Neonatology
Vol/bind	122
Udgave nummer	6
Sider (fra-til)	677-684
Antal sider	8
ISSN	1661-7800
DOI	https://doi.org/10.1159/000547546
Status	Udgivet - 2025

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Lavizzari, A., Hutten, G. J., Heiring, C., van de Loo, M., Onland, W., Alonso-Ojembarrena, A., Ehrhardt, H., Cetinkaya, M., Szczapa, T., Sartorius, V., Rocha, G., Wald, M., Soukka, H., Danhaive, O., Dassios, T., Cucerea, M. C., Calkovska, A., Dimitriou, G., Barzilay, B., ... ESPR Pulmonary Research Consortium (2025). Management of apnoea in extremely preterm infants - a European Survey. Neonatology, 122(6), 677-684. https://doi.org/10.1159/000547546

Lavizzari, A, Hutten, GJ, Heiring, C, van de Loo, M, Onland, W, Alonso-Ojembarrena, A, Ehrhardt, H, Cetinkaya, M, Szczapa, T, Sartorius, V, Rocha, G, Wald, M, Soukka, H, Danhaive, O, Dassios, T, Cucerea, MC, Calkovska, A, Dimitriou, G, Barzilay, B, Filipovic-Grcic, B, Hentschel, R, Thome, UH, Bohlin, K, Lista, G, Schulzke, S, Plavka, R, Tameliene, R, O Apos Donnell, CPF, van Kaam, AH, Sindelar, R, Klingenberg, C & ESPR Pulmonary Research Consortium 2025, 'Management of apnoea in extremely preterm infants - a European Survey', Neonatology, bind 122, nr. 6, s. 677-684. https://doi.org/10.1159/000547546

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title = "Management of apnoea in extremely preterm infants - a European Survey",

abstract = "INTRODUCTION: Episodes of apnoea are common in extremely preterm infants (EPIs) and usually treated with caffeine and respiratory support. Understanding differences in apnoea definitions, monitoring practices, and use of respiratory stimulants is essential to improve future treatment.METHODS: Between March and July 2024, one lead consultant at European tertiary neonatal intensive care units (NICUs) was invited to complete a web-based survey on respiratory practices in EPIs. We sought information how they defined apnoea and monitored for it, and how they treated it with caffeine, doxapram, and non-invasive respiratory support.RESULTS: We received replies from 447/721 (62%) NICUs across 24 European countries. Most NICUs (74%) use both electrocardiogram electrodes and pulse oximetry for apnoea monitoring. All NICUs reported using caffeine citrate, with 102 centres (23%) starting it in the delivery room. The median loading, maintenance and maximum maintenance doses used are 20 mg/kg, 5 and 10 mg/kg/day, respectively. Caffeine is occasionally given twice daily in some NICUs (30%) and stopped at 34-35 weeks of postmenstrual age at most of them (74%). Doxapram is used at 111 (25%) NICUs, with geographical differences. Strategies for the use and escalation of non-invasive respiratory support in case of persistent apnoea are not clearly defined. Automatic closed-loop oxygen delivery is used at 25% of NICUs.CONCLUSION: Despite consistency in the dosing and weaning of caffeine, there is much variation in the management of apnoea in preterm infants across Europe. Future research should focus on timing and dosage of caffeine, the use of doxapram, and strategies for optimising non-invasive respiratory support.",

keywords = "Apnea/therapy, Caffeine/administration & dosage, Citrates/therapeutic use, Doxapram/therapeutic use, Europe, Health Care Surveys, Humans, Infant, Extremely Premature, Infant, Newborn, Intensive Care Units, Neonatal/statistics & numerical data, Noninvasive Ventilation, Oximetry, Practice Patterns, Physicians'/statistics & numerical data, Surveys and Questionnaires, Apnoea, European survey, Infant, Doxapram, Preterm infants, Caffeine",

author = "Anna Lavizzari and Hutten, {G Jeroen} and Christian Heiring and {van de Loo}, Moniek and Wes Onland and Almudena Alonso-Ojembarrena and Harald Ehrhardt and Merih Cetinkaya and Tomasz Szczapa and Victor Sartorius and Gustavo Rocha and Martin Wald and Hanna Soukka and Olivier Danhaive and Theodore Dassios and Cucerea, {Manuela Camelia} and Andrea Calkovska and Gabriel Dimitriou and Bernard Barzilay and Boris Filipovic-Grcic and Roland Hentschel and Thome, {Ulrich H} and Kajsa Bohlin and Gianluca Lista and Sven Schulzke and Richard Plavka and Rasa Tameliene and {O Apos Donnell}, {Colm Patrick Finbarr} and {van Kaam}, {Anton H} and Richard Sindelar and Claus Klingenberg and {ESPR Pulmonary Research Consortium}",

note = "The Author(s). Published by S. Karger AG, Basel.",

year = "2025",

doi = "10.1159/000547546",

language = "English",

volume = "122",

pages = "677--684",

journal = "Neonatology",

issn = "1661-7800",

publisher = "S. Karger AG",

number = "6",

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TY - JOUR

T1 - Management of apnoea in extremely preterm infants - a European Survey

AU - Lavizzari, Anna

AU - Hutten, G Jeroen

AU - Heiring, Christian

AU - van de Loo, Moniek

AU - Onland, Wes

AU - Alonso-Ojembarrena, Almudena

AU - Ehrhardt, Harald

AU - Cetinkaya, Merih

AU - Szczapa, Tomasz

AU - Sartorius, Victor

AU - Rocha, Gustavo

AU - Wald, Martin

AU - Soukka, Hanna

AU - Danhaive, Olivier

AU - Dassios, Theodore

AU - Cucerea, Manuela Camelia

AU - Calkovska, Andrea

AU - Dimitriou, Gabriel

AU - Barzilay, Bernard

AU - Filipovic-Grcic, Boris

AU - Hentschel, Roland

AU - Thome, Ulrich H

AU - Bohlin, Kajsa

AU - Lista, Gianluca

AU - Schulzke, Sven

AU - Plavka, Richard

AU - Tameliene, Rasa

AU - O Apos Donnell, Colm Patrick Finbarr

AU - van Kaam, Anton H

AU - Sindelar, Richard

AU - Klingenberg, Claus

AU - ESPR Pulmonary Research Consortium

N1 - The Author(s). Published by S. Karger AG, Basel.

PY - 2025

Y1 - 2025

N2 - INTRODUCTION: Episodes of apnoea are common in extremely preterm infants (EPIs) and usually treated with caffeine and respiratory support. Understanding differences in apnoea definitions, monitoring practices, and use of respiratory stimulants is essential to improve future treatment.METHODS: Between March and July 2024, one lead consultant at European tertiary neonatal intensive care units (NICUs) was invited to complete a web-based survey on respiratory practices in EPIs. We sought information how they defined apnoea and monitored for it, and how they treated it with caffeine, doxapram, and non-invasive respiratory support.RESULTS: We received replies from 447/721 (62%) NICUs across 24 European countries. Most NICUs (74%) use both electrocardiogram electrodes and pulse oximetry for apnoea monitoring. All NICUs reported using caffeine citrate, with 102 centres (23%) starting it in the delivery room. The median loading, maintenance and maximum maintenance doses used are 20 mg/kg, 5 and 10 mg/kg/day, respectively. Caffeine is occasionally given twice daily in some NICUs (30%) and stopped at 34-35 weeks of postmenstrual age at most of them (74%). Doxapram is used at 111 (25%) NICUs, with geographical differences. Strategies for the use and escalation of non-invasive respiratory support in case of persistent apnoea are not clearly defined. Automatic closed-loop oxygen delivery is used at 25% of NICUs.CONCLUSION: Despite consistency in the dosing and weaning of caffeine, there is much variation in the management of apnoea in preterm infants across Europe. Future research should focus on timing and dosage of caffeine, the use of doxapram, and strategies for optimising non-invasive respiratory support.

AB - INTRODUCTION: Episodes of apnoea are common in extremely preterm infants (EPIs) and usually treated with caffeine and respiratory support. Understanding differences in apnoea definitions, monitoring practices, and use of respiratory stimulants is essential to improve future treatment.METHODS: Between March and July 2024, one lead consultant at European tertiary neonatal intensive care units (NICUs) was invited to complete a web-based survey on respiratory practices in EPIs. We sought information how they defined apnoea and monitored for it, and how they treated it with caffeine, doxapram, and non-invasive respiratory support.RESULTS: We received replies from 447/721 (62%) NICUs across 24 European countries. Most NICUs (74%) use both electrocardiogram electrodes and pulse oximetry for apnoea monitoring. All NICUs reported using caffeine citrate, with 102 centres (23%) starting it in the delivery room. The median loading, maintenance and maximum maintenance doses used are 20 mg/kg, 5 and 10 mg/kg/day, respectively. Caffeine is occasionally given twice daily in some NICUs (30%) and stopped at 34-35 weeks of postmenstrual age at most of them (74%). Doxapram is used at 111 (25%) NICUs, with geographical differences. Strategies for the use and escalation of non-invasive respiratory support in case of persistent apnoea are not clearly defined. Automatic closed-loop oxygen delivery is used at 25% of NICUs.CONCLUSION: Despite consistency in the dosing and weaning of caffeine, there is much variation in the management of apnoea in preterm infants across Europe. Future research should focus on timing and dosage of caffeine, the use of doxapram, and strategies for optimising non-invasive respiratory support.

KW - Apnea/therapy

KW - Caffeine/administration & dosage

KW - Citrates/therapeutic use

KW - Doxapram/therapeutic use

KW - Europe

KW - Health Care Surveys

KW - Humans

KW - Infant, Extremely Premature

KW - Infant, Newborn

KW - Intensive Care Units, Neonatal/statistics & numerical data

KW - Noninvasive Ventilation

KW - Oximetry

KW - Practice Patterns, Physicians'/statistics & numerical data

KW - Surveys and Questionnaires

KW - Apnoea

KW - European survey

KW - Infant

KW - Doxapram

KW - Preterm infants

KW - Caffeine

UR - http://www.scopus.com/inward/record.url?scp=105023547195&partnerID=8YFLogxK

U2 - 10.1159/000547546

DO - 10.1159/000547546

M3 - Journal article

C2 - 40914955

SN - 1661-7800

VL - 122

SP - 677

EP - 684

JO - Neonatology

JF - Neonatology

IS - 6

ER -

Management of apnoea in extremely preterm infants - a European Survey

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