Inclusion and exclusion criteria

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