Pharmacologic manipulation of the respiratory control center in the infant.

The respiratory control center receives afferent stimuli from mechanical and neuromechanical sources. Information from both these sources, combined with voluntary and involuntary CNS control, effects stimulation of the respiratory muscles. In the infant, insufficiency of one or more of these elements of the respiratory control center is associated with considerable morbidity and mortality. Pharmacologic manipulation may provide a means of intervention. The xanthine derivative theophylline has been successfully used in the treatment of bronchopulmonary dysplasia and apnea in the infant. Naloxone, an endorphin antagonist, is widely used for the reversal of narcotic-induced respiratory depression but has not been shown to be clinically effective for either severely or moderately asphyxiated infants. Although doxapram has not been extensively studied and lacks an oral preparation, it is a potentially viable therapy in the treatment of refractory apnea and congenital hypoventilation syndromes. Almitrine's success in adults with chronic obstructive pulmonary disease has not been duplicated in infants with similar respiratory impairments. Progesterone and prostaglandin, although proved to influence respiratory activity, should be regarded as very experimental therapeutic modalities.