Idiopathic apnea of prematurity remains a major clinical problem that requires treatment. For three decades, methylxanthines (caffeine and theophylline) have remained as the primary treatment choice. Several studies have shown the effectiveness of doxapram in reducing apnea refractory to methylxanthines, but numerous side effects have been reported, so that its use remains controversial. In this study, we examined a novel therapy in the form of olfactory stimulation in premature newborns suffering from apnea refractory to caffeine. Thirteen premature newborns born at 28 to 31 gestational weeks were exposed to a pleasant odor diffused during 24 hours in the incubator. A reduction of the number of apnea during the day with odorization compared to the day before (baseline) or the day after (recovery) occurred in all infants. In mean, the reduction reached 42%. Particularly, the apnea associated with episodes of bradycardia and hypoxemia decreased strongly (49%) and affected all the infants. Due to this reduction, no additional treatment with doxapram was necessary. Taken together, these data indicate that the introduction of a pleasant odor in the incubator is of therapeutic value in the treatment of apnea unresponsive to caffeine and give a new possibility to reduce the use of the controversial doxapram.
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