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Related Experiment Videos

Prophylactic methylxanthine for extubation in preterm infants.

D J Henderson-Smart1, P G Davis

  • 1NSW Centre for Perinatal Health Services Research, Queen Elizabeth II Institute for Mothers and Infants, Building DO2, University of Sydney, Sydney, NSW, Australia, 2006. dhs@mail.usyd.edu.au

The Cochrane Database of Systematic Reviews
|May 5, 2000
PubMed
Summary

Methylxanthine treatment may help some preterm infants successfully wean from mechanical ventilation and extubation. However, evidence does not support routine use, especially for infants over 1000g or older than one week.

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Area of Science:

  • Neonatal Medicine
  • Respiratory Physiology
  • Pharmacology

Background:

  • Preterm infants on intermittent positive pressure ventilation (IPPV) often face difficulties weaning and extubation due to poor respiratory drive.
  • Methylxanthine therapy initiated before extubation may enhance respiratory stimulation, potentially improving weaning success.

Purpose of the Study:

  • To determine if methylxanthine treatment reduces reintubation and IPPV use in preterm infants undergoing planned extubation.
  • To assess for clinically significant side effects associated with methylxanthine use in this population.

Main Methods:

  • A systematic review and meta-analysis of published trials comparing methylxanthine (theophylline or caffeine) with placebo or no treatment.
  • Included were randomized or quasi-random trials in preterm or low birth weight infants planned for extubation.

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  • Data analysis involved calculating relative risk and risk difference.

    • Main Results:

    • Overall analysis of four trials suggests methylxanthine treatment reduces the need for mechanical ventilation.
    • One small trial found no benefit, while another indicated effectiveness in infants <1000g and <1 week old.
    • No significant benefit was observed in infants >1kg or those older than one week, or those who had previously failed extubation.

    Conclusions:

    • Methylxanthines may aid extubation in specific preterm infants, particularly those of extremely low birth weight extubated within the first week.
    • Current evidence does not support routine methylxanthine use for extubation in infants >1000g or >1 week old.
    • Further research is needed, focusing on gestational age, caffeine as a treatment, and including side effects and neurodevelopmental outcomes.