Related Experiment Video
Updated: Mar 3, 2026
Application of an Amplitude-integrated EEG Monitor Cerebral Function Monitor to Neonates
Published on: September 6, 2017
Comparative Efficacy and Safety of Caffeine and Aminophylline for Apnea of Prematurity in Preterm (≤34 weeks)
M Shivakumar1, P Jayashree, Muhammad Najih
1Departments of Pediatrics and *Community Medicine, Women and Child block, Kasturba Hospital, Manipal. Correspondence to: Dr Leslie Edward Simon Lewis, Professor and Unit Head, Neonatal Intensive Care Unit, Department of Pediatrics, Kasturba Hospital, Manipal University Manipal 576 104, India. leslielewis1@gmail.com.
Insights
Aminophylline effectively reduced apnea spells in preterm infants, similar to caffeine. However, caffeine showed a lower risk of tachycardia, suggesting a need for dosage optimization for aminophylline to minimize toxicity.
Area of Science:
- Neonatal Medicine
- Pharmacology
- Pediatric Pulmonology
Background:
- Apnea of prematurity is a common respiratory challenge in preterm infants.
- Caffeine and aminophylline are commonly used to manage apnea of prematurity.
- Optimizing treatment for apnea of prematurity is crucial for infant outcomes.
Purpose of the Study:
- To compare the efficacy and safety of standard doses of caffeine and aminophylline in treating apnea of prematurity.
- To evaluate differences in apneic spells, respiratory morbidity, and adverse events between the two treatments.
- To assess the association between therapeutic drug levels and treatment efficacy.
Main Methods:
- A randomized controlled trial was conducted with 240 preterm neonates (≤34 weeks gestation).
- Infants were randomized to receive either caffeine citrate or aminophylline.
- Apneic spells, respiratory morbidity, and adverse events were primary outcome measures.
Main Results:
- Aminophylline treatment resulted in fewer apnea spells between 4-7 days of therapy (P=0.03).
- No significant differences were observed in apnea rates, desaturations, or hospital stay duration between groups.
- Aminophylline-treated infants had significantly higher mean heart rates and a greater risk of tachycardia (P<0.001).
Conclusions:
- Both caffeine and aminophylline demonstrate efficacy in preventing apneic spells in preterm neonates.
- Aminophylline may require dosage adjustments to mitigate risks of tachycardia and other toxicities.
- Caffeine appears to have a safer cardiac profile compared to aminophylline in this population.
Objective:
To compare the efficacy and safety of standard doses of Caffeine and Aminophylline for Apnea of prematurity.
Study Design:
Randomized controlled trial.
Setting:
Tertiary-care referral centre and a teaching institution in Southern India. Trial was conducted from February 2012 to January 2015.
Participants:
240 preterm (≤34 wk) neonates with apnea of prematurity.
Interventions:
Neonates randomized into two groups: Caffeine group received loading dose of caffeine citrate (20 mg/kg) followed by 5 mg/kg/day maintenance dose every 24 hour. Aminophylline group received loading dose of Aminophylline - 5 mg/kg and maintenance dose of 1.5 mg/kg 8-hourly.
Outcome Measures:
Difference in apneic spells, associated respiratory morbidity, and acute adverse events were assessed. Association of efficacy with therapeutic drug levels was also evaluated.
Results:
Infants on aminophylline experienced less apnea spells in 4-7 days of therapy (P=0.03). Mean apnea rate and isolated desaturations were similar in 1-3, 4-7 and 8-14 days of therapy. No difference was noted in duration of Neonatal Intensive Care Unit stay and hospital stay. Mean heart rate was significantly high in Aminophylline group (P<0.001). Risk of developing tachycardia was less (RR 0.30; 95% CI range 0.15 to 0.60; P<0.001) in Caffeine- over Aminophylline-treated infants.
Conclusion:
Aminophylline is as effective as caffeine for prevention of apneic spells in preterm neonates; however, dosage optimization needs to be done to reduce toxicity.
Related Concept Videos
01:24Antiasthma Drugs: Methylxanthines
Theophylline is thought to inhibit phosphodiesterase enzymes, increasing intracellular levels of cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP). This rise in cAMP and cGMP concentrations stimulates cardiac function,...
01:28Adrenergic Agonists: Mixed-Action Agents
Ephedrine and pseudoephedrine lack a catecholamine group, making them less susceptible to degradation by metabolic enzymes. They have increased oral bioavailability and lipophilicity, resulting in a longer duration of action. Their response is reduced by...
01:30Adrenergic Agonists: Therapeutic Uses
Emergency and Intensive Care Unit (ICU) applications: Pressor agents increase blood pressure, heart rate, and contractility in shock and organ failure situations. Dopamine can induce vasodilation and stimulate adrenoceptors. Endogenous catecholamines are effective in treating cardiogenic shock. α2-agonists like clonidine can reverse anesthesia-induced hypertension.
Allergies and...
01:23Upper Respiratory Drugs: Antitussives, Expectorants, and Mucolytics
Antitussives include codeine, dextromethorphan (Robitussin), and benzonatate (Tessalon). Codeine and dextromethorphan exert their effects centrally by suppressing the cough reflex center in the medulla. Benzonatate operates peripherally within the respiratory tract by...
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
01:20Inhalational Anesthetics: Overview