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Apnea of prematurity: theophylline v. caffeine
1Alaska Neonatology Associates, Providence Hospital, Anchorage 99508.
Insights
Theophylline and caffeine citrate effectively treat apnea in preterm infants. Caffeine citrate is particularly effective for persistent apnea unresponsive to theophylline, normalizing pneumocardiograms.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Clinical Pharmacology
Background:
- Preterm infants frequently experience apnea, a potentially serious condition affecting respiratory control.
- Pneumocardiograms are essential for monitoring cardiorespiratory events in neonates.
- Apnea and periodic breathing are common challenges in preterm infant care.
Purpose of the Study:
- To evaluate the efficacy of theophylline and caffeine citrate in managing apnea in preterm infants.
- To compare the effectiveness of these methylxanthines in normalizing pneumocardiograms.
- To identify optimal treatment strategies for persistent apnea unresponsive to initial therapy.
Main Methods:
- Conducted 12-hour pneumocardiograms on 277 preterm infants over 15 months.
- Defined and measured apnea density and periodic breathing index.
- Administered theophylline for apnea density >= 5, followed by caffeine citrate for persistent cases.
Main Results:
- Sixty infants (24%) received theophylline for significant apnea.
- 16 infants (27% of those on theophylline) required caffeine citrate due to persistent apnea.
- Caffeine citrate reduced apnea density to 0.8 in 88% of infants, demonstrating high efficacy.
Conclusions:
- Both theophylline and caffeine citrate are effective in treating apnea in preterm infants.
- Caffeine citrate is a valuable option for persistent apnea unresponsive to theophylline.
- Methylxanthine therapy can normalize pneumocardiograms, improving cardiorespiratory stability in neonates.
Abstract:
During a fifteen month period, 401 two channel (heart rate and respiratory impedance), 12 hour pneumocardiograms on 277 preterm infants were performed. Each pneumocardiogram was evaluated according to the following set of criteria: prolonged apnea (apnea > 19 seconds or shorter if associated with heart rate of < 80bpm for > 2 seconds or observed cyanosis); short apnea (apnea 10-19 seconds); periodic breathing (normal respiratory pattern interrupted by > 2 breathing pauses of > 5 seconds during > 1 minute duration). Apnea density was used as prime measure in determining abnormal pneumocardiograms and was defined by total apnea time (seconds) x 100 divided by recording time while periodic breathing index defined by total periodic breathing time (minutes) x 100 divided by recording time. Sixty infants (24%) had apnea densities > or = 5 which prompted therapy with theophylline. Sixteen of these infants (27%) failed to resolve their apnea within 7 days (apnea density > or = 3) and were placed on caffeine citrate. Caffeine decreased the apnea density of fourteen of these infants (88%) to 0.8 (95% CI; 0-2.3). Efficacy of both methylxanthines to normalize the pneumocardiogram was similar (p = 0.5). Persistent apnea unresponsive to theophylline may respond to orally administered caffeine citrate.