The use of primidone in neonates with theophylline-resistant apnea

C. A. Miller, M. Gaylord, V. Lorch and A. W. Zimmerman
Department of Pediatrics, University of Tennessee School of Medicine, Knoxville 37920.

OBJECTIVE--To determine whether primidone reduced the occurrence of apnea of prematurity in neonates with apnea resistant to theophylline. DESIGN--Retrospective review. SETTING--Neonatal intensive care unit. PARTICIPANTS--Sixteen premature infants (mean age, 27.8 weeks) in whom apnea and bradycardia recurred despite therapeutic levels of theophylline. Six of the patients were receiving assisted ventilation. INTERVENTION--Administration of primidone (10 to 15 mg/kg per day) orally or by nasogastric tube at a mean age of 35 days. RESULTS--Apnea and bradycardia decreased significantly 24 to 72 hours after initiation of primidone treatment (by 68% and 69%, respectively) compared with pretreatment events. We obtained similar results after a separate analysis of the 10 patients who had been weaned from assisted ventilation before treatment with primidone. No toxic reactions were observed. CONCLUSIONS--Primidone represents a possible adjuvant therapy in theophylline-resistant apnea of prematurity. Caution is advised, because of primidone's complex pharmacologic characteristics, until there are further controlled prospective studies.