Amplitude-integrated electroencephalography shows that doxapram influences the brain activity of preterm infants

Aim: The aim of this study was to measure the brain activity of preterm infants treated with caffeine citrate and doxapram for preterm apnoea, using amplitude-integrated electroencephalography (aEEG), to identify any adverse effects on cerebral function. Methods: We analysed the aEEG tracings of 13 preterm infants <30 weeks of gestation before, during and after doxapram treatment, with regard to background activity (percentages of continuous and discontinuous patterns), occurrence of sleep-wake cycling and appearance of electrographic seizure activity. They were also compared with 61 controls without doxapram treatment. Results: During doxapram treatment, aEEG tracings showed an increase in continuous background activity (19 +/- 30% before treatment, 38 +/- 35% during treatment) and a decrease in discontinuous patterns. In addition, they showed more frequent electrographic seizure activity (0% before treatment, 15 +/- 37% during treatment) and less frequent sleep-wake cycling (92 +/- 27% before treatment, 85 +/- 37% during treatment) could be observed. These results were confirmed when compared to the control group. Conclusion: Doxapram treatment influences aEEG in preterm infants, showing higher percentages of continuous activity as well as more electrographic seizure activity and less sleep-wake cycling. It should, therefore, be used with caution in very preterm infants.