Cochrane · systematic review · CD014145
Doxapram for the prevention and treatment of apnea in preterm infants
Evans, S, Avdic, E, Pessano, S, et al. · Cochrane Database of Systematic Reviews · 2023 · Cochrane Library
NeonatalAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
36
current version
GRADE rated
12
No studies
24
Included studies
NR
No studies 24 · 66.7%Ungraded 0 · 0%Very low 7 · 19.4%Low 5 · 13.9%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Doxapram compared to no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or as adjunct therapy to methylxanthine compared to methylxanthine alone for treatment of apnea
Population: treatment of apnea
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
1a. Failed apnea reduction after 2–7 days – doxapram compared to no treatment for the treatment of apnea Doxapram vs no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or | RR 0.45 [0.2, 1.05] | 1 study · 21 participants | Low Downgraded: imprecision |
1b. Failed apnea reduction after 2–7 days – doxapram compared to alternative treatment for the treatment of apnea Doxapram vs no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or | RR 1.35 [0.53, 3.45] | 4 studies · 84 participants | Very low Downgraded: risk of bias, imprecision |
1c. Failed apnea reduction after 2–7 days – doxapram as an adjunct to methylxanthine compared to methylxanthine alone for the treatment of apnea Doxapram vs no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or | RR 0.08 [0.01, 1.17] | 1 study · 10 participants | Very low Downgraded: risk of bias, imprecision |
2a. Need for positive pressure ventilation after initiation of treatment – doxapram compared to no treatment for the treatment of apnea Doxapram vs no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or | RR 0.31 [0.01, 6.74] | 1 study · 21 participants | Very low Downgraded: imprecision |
2b. Need for positive pressure ventilation after initiation of treatment – doxapram compared to alternative treatment for the treatment of apnea Doxapram vs no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or | RR 2.4 [0.11, 51.32] | 2 studies · 37 participants | Very low Downgraded: imprecision |
2c. Need for positive pressure ventilation after initiation of treatment – doxapram as an adjunct to methylxanthine compared to methylxanthine alone for the treatment of apnea Doxapram vs no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or | no estimate extracted | NR | No studies |
3a. Chronic lung disease at 36 weeks' postmenstrual age (defined as supplemental oxygen at 36 weeks' gestation) – doxapram compared to no treatment for the treatment of apnea Doxapram vs no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or | no estimate extracted | NR | No studies |
3b. Chronic lung disease at 36 weeks' postmenstrual age (defined as supplemental oxygen at 36 weeks' gestation) – doxapram compared to alternative treatment for the treatment of apnea Doxapram vs no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or | no estimate extracted | NR | No studies |
3c. Chronic lung disease at 36 weeks' postmenstrual age (defined as supplemental oxygen at 36 weeks' gestation) – doxapram as an adjunct to methylxanthine compared to methylxanthine alone for the treatment of apnea Doxapram vs no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or | no estimate extracted | NR | No studies |
4a.Death at any time during initial hospitalization – doxapram compared to no treatment for the treatment of apnea Doxapram vs no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or | no estimate extracted | NR | No studies |
4b. Death at any time during initial hospitalization – doxapram compared to alternative treatment for the treatment of apnea Doxapram vs no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or | no estimate extracted | NR | No studies |
4c. Death at any time during initial hospitalization – doxapram as an adjunct to methylxanthine compared to methylxanthine alone for the treatment of apnea Doxapram vs no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or | no estimate extracted | NR | No studies |
5a. Moderate‐to‐severe neurodevelopmental disability or intellectual impairment after 2 years of age – doxapram compared to no treatment for the treatment of apnea Doxapram vs no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or | no estimate extracted | NR | No studies |
5b. Moderate‐to‐severe neurodevelopmental disability or intellectual impairment after 2 years of age – doxapram compared to alternative treatment for the treatment of apnea Doxapram vs no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or | no estimate extracted | NR | No studies |
5c. Moderate‐to‐severe neurodevelopmental disability or intellectual impairment after 2 years of age – doxapram as an adjunct to methylxanthine compared to methylxanthine alone for the treatment of apnea Doxapram vs no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or | no estimate extracted | NR | No studies |
6a. Side effects causing cessation of therapy – doxapram compared to no treatment for the treatment of apnea Doxapram vs no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or | no estimate extracted | 1 study · 21 participants | Low Downgraded: imprecision |
6b. Side effects causing cessation of therapy – doxapram compared to alternative treatment for the treatment of apnea Doxapram vs no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or | no estimate extracted | 2 studies · 37 participants | Low Downgraded: imprecision |
6c. Side effects causing cessation of therapy – doxapram as an adjunct to methylxanthine compared to methylxanthine alone for the treatment of apnea Doxapram vs no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or | no estimate extracted | NR | No studies |
Doxapram compared to no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or as adjunct therapy to methylxanthine compared to methylxanthine alone for prevention of reintubation
Population: prevention of reintubation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
1a.'Clinical apnea' after initiation of treatment – doxapram compared to no treatment for the prevention of reintubation Doxapram vs no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or | no estimate extracted | NR | No studies |
1b. 'Clinical apnea' after initiation of treatment – doxapram compared to alternative treatment for the prevention of reintubation Doxapram vs no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or | no estimate extracted | NR | No studies |
1c.'Clinical apnea' after initiation of treatment – doxapram as an adjunct to methylxanthine compared to methylxanthine alone for the prevention of reintubation Doxapram vs no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or | RR 0.36 [0.13, 0.98] | 1 study · 56 participants | Low Downgraded: imprecision |
2a. Failed apnea reduction after 2–7 days – doxapram compared to no treatment for the prevention of reintubation Doxapram vs no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or | no estimate extracted | NR | No studies |
2b. Failed apnea reduction after 2–7 days – doxapram compared to alternative treatment for the prevention of reintubation Doxapram vs no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or | RR 0.43 [0.1, 1.83] | 1 study · 25 participants | Very low Downgraded: risk of bias, imprecision |
2c. Failed apnea reduction after 2–7 days – doxapram as an adjunct to methylxanthine compared to methylxanthine alone for the prevention of reintubation Doxapram vs no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or | RR 0.92 [0.52, 1.62] | 1 study · 56 participants | Low Downgraded: imprecision |
3a. Chronic lung disease at 36 weeks' postmenstrual age – doxapram compared to no treatment for the prevention of reintubation Doxapram vs no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or | no estimate extracted | NR | No studies |
3b. Chronic lung disease at 36 weeks' postmenstrual age – doxapram compared to alternative treatment for the prevention of reintubation Doxapram vs no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or | no estimate extracted | NR | No studies |
3c. Chronic lung disease at 36 weeks' postmenstrual age – doxapram as an adjunct to methylxanthine compared to methylxanthine alone for the prevention of reintubation Doxapram vs no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or | no estimate extracted | NR | No studies |
4a. Death (at any time during initial hospitalization) – doxapram compared to no treatment for the prevention of reintubation Doxapram vs no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or | no estimate extracted | NR | No studies |
4b. Death (at any time during initial hospitalization) – doxapram compared to alternative treatment for the prevention of reintubation Doxapram vs no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or | no estimate extracted | NR | No studies |
4c. Death (at any time during initial hospitalization) – doxapram as an adjunct to methylxanthine compared to methylxanthine alone for the prevention of reintubation Doxapram vs no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or | RR 1.43 [0.34, 6.01] | 2 studies · 85 participants | Very low Downgraded: risk of bias, imprecision |
5a.Moderate‐to‐severe neurodevelopmental disability or intellectual impairment after 2 years of age – doxapram compared to no treatment for the prevention of reintubation Doxapram vs no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or | no estimate extracted | NR | No studies |
5b. Moderate‐to‐severe neurodevelopmental disability or intellectual impairment after 2 years of age – doxapram compared to alternative treatment for the prevention of reintubation Doxapram vs no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or | no estimate extracted | NR | No studies |
5c. Moderate‐to‐severe neurodevelopmental disability or intellectual impairment after 2 years of age – doxapram as an adjunct to methylxanthine compared to methylxanthine alone for the prevention of reintubation Doxapram vs no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or | no estimate extracted | NR | No studies |
6a. Side effects causing cessation of therapy – doxapram compared to no treatment for the prevention of reintubation Doxapram vs no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or | no estimate extracted | NR | No studies |
6b. Side effects causing cessation of therapy – doxapram compared to alternative treatment for the prevention of reintubation Doxapram vs no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or | no estimate extracted | NR | No studies |
6c. Side effects causing cessation of therapy – doxapram as an adjunct to methylxanthine compared to methylxanthine alone for the prevention of reintubation Doxapram vs no treatment, placebo, methylxanthine (including theophylline, aminophylline, or caffeine), or | RR 6.42 [0.8, 51.26] | 2 studies · 85 participants | Very low Downgraded: risk of bias, imprecision |