Abstract
BackgroundMethylxanthines (caffeine; aminophylline/theophylline) are commonly used for apnea of prematurity (AOP) treatment. We aimed to compare the efficacy and adverse effects of caffeine and aminophylline/theophylline.MethodsA retrospective case–control gestational age-matched study investigates patients born between January 2017 and December 2018, 23–35 weeks gestation with birth weights >500 g treating AOP with caffeine or aminophylline/theophylline.ResultsThere were 144 cases (48 in caffeine group and 96 in aminophylline/theophylline group). The median treatment durations were 11 and 17 days in caffeine and aminophylline/theophyllinegroup (p = 0.002). When tachycardia is defined as heart rate ≥160 bpm, the rates were 8.3 and 34.4% in caffeine and control group (p = 0.001). When tachycardia is defined as 10 bpm over baseline heart rate, the rates were 41.7 and 63.5% in caffeine and aminophylline/theophylline group (p = 0.01). Stratified by gestational age and sex, significant reductions in tachycardia rates with caffeine than with theophylline were limited to male infants and infants born at <30 weeks gestation.ConclusionsFor apnea treatment, caffeine has greater efficacy and fewer tachycardia than aminophylline/theophylline, especially in male infants and infants born at <30 weeks gestation.
Highlights
Premature infants have structurally and functionally immature organs
A total of 59 infants with Apnea of prematurity (AOP) treated with caffeine were examined
We excluded four infants who had received both caffeine and aminophylline/theophylline during hospitalization, four infants with significant congenital abnormalities, and three infants who were discharged with home ventilators [two were treated with bilevel positive airway pressure (BiPAP), one underwent tracheostomy with BiPAP, and one was treated with a high-flow ventilator]
Summary
Premature infants have structurally and functionally immature organs. An immature respiratory control system is less responsive to changes in carbon dioxide levels, contributing to apnea [1]. This is one of the most common phenomena impacting premature infants in the neonatal intensive care unit (NICU) [2]. Apnea of prematurity (AOP) is defined as a cessation of breathing for ≥20 or < 20 s accompanied by bradycardia (heart rate
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