In cases of suspected apnea in preterm infants, what is the preferred initial intervention?

In cases of suspected apnea in preterm infants, caffeine therapy is the preferred initial intervention because it acts as a respiratory stimulant. Apnea of prematurity is commonly characterized by episodes of cessation of breathing for more than 20 seconds, often accompanied by bradycardia and oxygen desaturation. Caffeine stimulates the central nervous system and can help enhance the respiratory drive in these infants, leading to fewer apnea episodes.

Caffeine not only helps the infant breathe more effectively but also reduces the overall incidence of apnea events and the need for more invasive supportive measures, such as mechanical ventilation. This makes it a favorable first-line approach, especially since it is also relatively safe and can be administered orally or via intravenous route.

Other interventions, such as supplemental oxygen, may be necessary depending on the infant's oxygen saturation levels but do not address the underlying issue of apnea directly. Similarly, routine resuscitation might be required in cases of severe respiratory compromise but is not the immediate first choice in managing apnea itself. Mechanical ventilation is generally reserved for more severe cases or when other interventions fail, making it less optimal as an initial approach. Caffeine therapy, therefore, stands out as the targeted and effective initial treatment for suspected apnea in preterm infants.