Turkiye Klinikleri Journal of Pediatrics

.: REVIEW
Prematüre Apnesinde Kafein Tedavisi: Geleneksel Derleme
Caffeine Therapy in Apnea of Prematurity: Traditional Review
Özmert Muhammet Ali ÖZDEMİRa
aPamukkale Üniversitesi Tıp Fakültesi, Neonatoloji BD, Denizli, Türkiye
Turkiye Klinikleri J Pediatr. 2023;32(1):56-65
doi: 10.5336/pediatr.2022-92416
Article Language: TR
Full Text
ÖZET
 Prematüre apnesi, yenidoğan yoğun bakım ünitelerinde prematüre bebeklerde sıklıkla karşılaşılan bir durum olup, solunumun 15-20 sn'den daha fazla durması ya da daha kısa süreli solunum kesintisine oksijen satürasyon düşüklüğü ve/veya bradikardinin eşlik etmesi olarak tanımlanır. Gebelik haftası 28'in altında doğan bebeklerin hemen tümünde apne görülürken, gebelik haftası büyüdükçe apne sıklığı azalmaktadır. Prematüre doğumun getirdiği nörolojik immatürite ile birlikte apne nedeniyle araya giren hipoksemi ve bradikardi atakları, bu bebeklerde nörolojik hasarlanma riskini artırmakta ve uzun dönemde; serebral palsi, gelişimsel koordinasyon bozukluğu, bilişsel ve davranışsal bozukluklar, bronkopulmoner displazi ve prematüre retinopatisi gibi önemli morbiditelere neden olabilmektedir. Bu nedenle prematüre bebeklerde apne tanısı ve tedavisi önem arz etmekte, apnenin farmakolojik tedavisinde de ilk tercih olarak bir metilksantin türevi olan kafein yer almaktadır. Kafein, yapısal olarak adenozine benzemekte ve etkisi doza bağımlı olarak başlıca adenozin reseptörleri üzerinden olmaktadır. Kafein, prematüre apnesinde adenozin ile baskılanmış medüller solunum merkezi inhibisyonunu ortadan kaldırmakta, gama aminobütirik asit salınımını önleyerek sinirsel uyarılmayı artırmakta, santral sinir sisteminin kan karbondioksit düzeylerine hassasiyeti artırmakta, böylece apneli bebeklerde solunumu uyarmakta ve devamlılığını sağlamaktadır. Bu derlemede, prematüre bebeklerde apne tedavisinde ilk tercih olan kafeinin etkisi, kimlere, ne zaman, hangi dozda ve ne kadar süre kullanmamız gerektiğiyle ilgili bilgiler, son literatür bilgileri ışığında verilmeye çalışılmıştır.

Anahtar Kelimeler: Kafein; prematüre bebek; apne
ABSTRACT
 Apnea of prematurity is a frequently encountered condition in premature infants in the neonatal-intensive-care-units and is defined as respiratory arrest for more than 15-20 seconds or short-term respiratory interruption accompanied by low oxygen-saturation and/or bradycardia. While apnea is observed in almost all babies born below 28 weeks of gestation, the frequency of apnea decreases as the gestational week gets older. Hypoxemia and bradycardia attacks intervening due to apnea together with the neurological immaturity caused by premature-birth increase the risk of neurological damage in these babies and in the long term; it can cause significant morbidities such as cerebral palsy, developmental coordination disorder, cognitive and behavioral disorders, bronchopulmonary dysplasia, and retinopathy of prematurity. For this reason, the diagnosis and treatment of apnea in premature infants is important, and caffeine, a methylxanthine derivative, is the first choice in the pharmacological treatment of apnea. Caffeine is structurally similar to adenosine and its effect is dose-dependent mainly on adenosine receptors. Caffeine eliminates the inhibition of the medullary-respiratory-center suppressed by adenosine in apnea of prematurity, increases neural excitation by preventing gammaaminobutyric acid release, increases the sensitivity of the central nervous system to blood carbon-dioxide levels, thus it stimulates and maintains respiration in infants with apnea. In this review, the effect of caffeine, which is the first choice in the treatment of apnea in premature infants, information about who, when, in which dose, and for how long we should use it, has been tried to be given in the light of the recent literature data.

Keywords: Caffeine; premature infant; apnea
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