A 30-week preterm neonate has increasing apneic spells beyond 48 hours of age despite caffeine citrate therapy. The apnea is not associated with bradycardia or desaturation, and the baby arouses promptly after each episode. What is the next best step in management?
- A Initiate nasal intermittent positive pressure ventilation ✓
- B Switch caffeine to aminophylline infusion
- C Start doxapram infusion
- D Increase caffeine dose to loading dose again
Correct answer: A. Initiate nasal intermittent positive pressure ventilation
Explanation
Apnea of prematurity refractory to methylxanthines is managed by escalating respiratory support, and nasal intermittent positive pressure ventilation is the accepted next step because it provides intermittent distending pressure that splints the upper airway. Doxapram is reserved for exceptional refractory cases and carries risks of gastrointestinal perforation and neurotoxicity.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.