Background and aims After the implementation of a local treatment protocol at our NICU, we aimed to systematically evaluate if intubation for apnea of prematurity was avoided by doxapram. We asked, if frequency and severity of apneas were affected and if side effects occurred.

Methods We prospectively analysed all premature infants < 30 weeks treated according to a standardised protocol during 10/2010 to 04/2013. Doxapram was given only, if otherwise intubation had been necessary. We registered the number of apneas, bradycardias, and desaturations, pCO₂ and side effects an hour before, at the start of, and during 48 h after onset of treatment.

Results 21 of 66 (31.8%) infants (mean gestational age 25.5 weeks, mean birth weight 705 g) were treated during 2½ years. All of them had been treated with caffeine and CPAP before doxapram was applied. In 13 of 67 (19%) therapy courses, infants were intubated because of persistent apnea during 48 h of doxapram treatment. The frequency of apneas (2.7 vs. 0.2), bradycardias <80/min (1.0 vs. 0.2), and desaturations <80% (3.4 vs. 1.1) per hour decreased. Therapy was ceased in 5 cases because of side effects (gastrointestinal disturbances, seizure, extreme myoclonia).

Conclusions Intubation was avoided in a large proportion of cases. In addition, frequency and severity of apneas diminished. Thus, doxapram seems to be effective. However, in face of side effects and lack of long term outcome data, it should be used with caution. Randomised studies are needed to achieve more information about efficacy and safety.