Does a preterm infant with a history of apnea of prematurity, who is intubated and on a ventilator, still require Aminophylline (methylxanthine) for apnea of prematurity prevention?

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Aminofilin Tidak Diperlukan pada Bayi Prematur yang Terintubasi dan Menggunakan Ventilator

Bayi prematur yang sudah terintubasi dan menggunakan ventilator mekanik TIDAK memerlukan aminofilin (atau kafein) untuk pencegahan apnea of prematurity, karena ventilator mekanik sudah menggantikan fungsi stimulasi pernapasan yang diberikan oleh metilxantin. 1

Mekanisme dan Rasional

  • Metilxantin (aminofilin/kafein) bekerja dengan menstimulasi pusat pernapasan di sistem saraf pusat, meningkatkan ventilasi semenit, menurunkan ambang batas terhadap hiperkapnia, dan meningkatkan tonus otot skeletal 1

  • Pada bayi yang terintubasi, ventilator mekanik secara langsung mengontrol dan mendukung pernapasan, sehingga mekanisme kerja metilxantin menjadi tidak relevan 1

  • Indikasi utama kafein adalah untuk apnea of prematurity yang didefinisikan sebagai episode apnea >20 detik atau lebih pendek namun disertai sianosis dan bradikardia, pada bayi yang bernapas spontan 1, 2

Kapan Metilxantin Diperlukan

Metilxantin hanya diperlukan pada bayi prematur yang:

  • Bernapas spontan (tidak terintubasi) dan mengalami episode apnea berulang 1, 2

  • Menggunakan CPAP atau dukungan pernapasan non-invasif lainnya namun masih mengalami apnea 2, 3

  • Dalam proses persiapan ekstubasi untuk mencegah kegagalan ekstubasi akibat apnea 2, 4

Algoritma Penggunaan Metilxantin

Untuk bayi yang sedang terintubasi:

  • JANGAN berikan metilxantin selama masih menggunakan ventilator mekanik 1
  • Pertimbangkan memulai kafein 12-24 jam SEBELUM rencana ekstubasi untuk memfasilitasi keberhasilan ekstubasi 2, 4

Untuk bayi yang bernapas spontan dengan apnea:

  • Berikan loading dose kafein sitrat 20 mg/kg (setara 10 mg/kg kafein base) 1
  • Dilanjutkan maintenance dose 5 mg/kg/hari (setara 2.5 mg/kg kafein base) 1
  • Kafein lebih dipilih dibanding aminofilin karena indeks terapeutik lebih luas dan pemberian sekali sehari 2

Peringatan Penting

  • Pemberian metilxantin pada bayi terintubasi tidak memberikan manfaat tambahan dan hanya menambah risiko efek samping seperti takikardia (pada kadar plasma >13 mg/L), peningkatan konsumsi oksigen, dan gangguan homeostasis glukosa 5

  • Waktu paruh kafein pada neonatus sangat panjang (3-4 hari) dibanding dewasa (5 jam), sehingga risiko akumulasi dan toksisitas lebih tinggi 1

  • Jika bayi memerlukan intubasi ulang setelah ekstubasi, hentikan sementara metilxantin karena ventilator sudah mengambil alih fungsi pernapasan 2, 4

References

2
Research

Treatment of apnea of prematurity.

Paediatric drugs, 2003

4
Research

Apnea of prematurity: from cause to treatment.

European journal of pediatrics, 2011

5
Research

Pharmacologic effects of theophylline in the newborn.

The Journal of allergy and clinical immunology, 1986

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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