Inclusion criteria:
- Admitted to the NICU of one of the participating centres
- Written informed consent according to the national guidelines of both (th Netherlands) or at least one (Belgium) parents or legal representatives
- Gestational age at birth <29 weeks
- Caffeine therapy, adequately dosed
- Optimal non-invasively supported according to the local treatment policy (with nasal CPAP or ventilation ((S)NIPPV, BIPAP/Duopap)
- Apnea that require a medical intervention (indication to start doxapram if not in trial) as judged by the attending physician
Exclusion criteria:
- Previous use of open label doxapram
- Use of theophylline (to replace doxapram)
- Chromosomal defects (e.g. trisomy 13, 18, or 21)
- Major congenital malformations that:
- compromise lung function (e.g. surfactant protein deficiencies, congenital diaphragmatic hernia)
- result in chronic ventilation (e.g. Pierre Robin sequence)
- increase the risk of death of adverse neurodevelopmental outcome (congenital cerebral malformations, chromosomal abnormalities)
- Palliative care or treatment limitations because of high risk of impaired outcome