Abstract
Caffeine is the most commonly used methyl xanthine for the prevention of apnoea in prematurity, but the ideal dose was uncertain, until now. This study compared two doses of caffeine for the prevention of apnoea in prematurity. A clinical trial was conducted on 78 preterm infants ≤32 weeks in Neonatal Intensive Care Unit. They were randomly allocated to receive the intervention (loading 40 mg/kg/day and maintenance of 20 mg/kg/day) or the control (loading 20 mg/kg/day and maintenance of 10 mg/kg/day) dose of caffeine. The primary outcome of the study was the frequency and total days of apnoea per duration of treatment for both groups. The frequency of apnoea ranged from zero to fourteen in the intervention group and zero to twelve in the control group. There was no statistically significant difference between the groups, with a p-value of 0.839. The number of days of apnoea was also similar between both groups, with a p-value of 0.928. There was also no significant difference in adverse events between both regimens. This study did not support the use of higher doses of caffeine as a prevention for apnoea in prematurity.
Highlights
Apnoea of prematurity is a significant clinical problem reflecting the immaturity of respiratory control systems [1,2]
A Cochrane review showed that caffeine was superior to other methylxanthines for the prevention and treatment of apnoea in prematurity in view of its lower toxicity and wider therapeutic index [4]
The caffeine for apnoea in prematurity (CAP) trial has shown that the benefits of caffeine therapy outweigh any potential risk up to the corrected age of 18 to 24 months [5]
Summary
Apnoea of prematurity is a significant clinical problem reflecting the immaturity of respiratory control systems [1,2]. The incidence is widely variable depending on the gestational age. A Cochrane review showed that caffeine was superior to other methylxanthines for the prevention and treatment of apnoea in prematurity in view of its lower toxicity and wider therapeutic index [4]. The caffeine for apnoea in prematurity (CAP) trial has shown that the benefits of caffeine therapy outweigh any potential risk up to the corrected age of 18 to 24 months [5]. A subsequent follow-up of the CAP trial has shown that caffeine therapy reduces the severity of motor impairments at five years of corrected age [6]. Caffeine is widely used as a standard treatment for apnoea in prematurity. Side effects of caffeine are relatively rare, but include tachycardia, jitteriness, feeding intolerance, increased oxygen consumption, and transient decrease in the rate of growth [2,7]
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