Caffeine versus aminophylline in combination with oxygen therapy for apnea of prematurity: A retrospective cohort study

Abstract

The present study was conducted to investigate the clinical significance of caffeine and aminophylline in the treatment of premature infants with apnea under varying conditions of oxygen (O 2) delivery. The clinical data of 120 premature infants with apnea treated with oxygen therapy and either caffeine citrate (20 mg/kg/day; n=77) or aminophylline (10 mg/kg/day; n=43) were retrospectively examined. The therapeutic performance of the drugs after the completion of the treatment was evaluated primarily according to the risk of recurrent episodes of apnea, the changes in the duration and concentration of inhaled O 2 and the incidence of complications. In contrast to aminophylline, caffeine treatment significantly reduced the duration of O 2 inhalation and the inhaled O 2 concentration in the infants treated with mechanical ventilation or O 2 delivery devices (P<0.05). Treatment with caffeine also decreased the incidence of recurrent apnea events and complications in the investigated population (P<0.05 or P<0.01). Caffeine performs better than aminophylline in the treatment of premature infants with apnea under different conditions of O 2 delivery. The therapeutic performance of caffeine is achieved primarily via improving the efficacy of supplemental O 2 and reducing the incidence of complications.

Comparative efficacy and safety of caffeine citrate and aminophylline in treating apnea of prematurity: A systematic review and meta-analysis

“…Then, 326 studies were excluded by screening titles and abstracts. Finally, two randomized controlled trials and eight observational studies were considered eligible for inclusion [15][16][17][18][19][20][21][22][23][24]. The flowchart depicts the selection procedure for the ten studies (Fig 1).…”

Use of caffeine for managing apneia of premature

“…The use of caffeine citrate has short and long-term benefits, including reducing the incidence of retinopathy of prematurity, bronchopulmonary dysplasia and benefits in motor function at 5 years . Despite this, it is possible to observe some side effects related to the use of this substance, being they tachycardia, increased oxygen consumption, food intolerance, nervousness and reduced heart rate growth (Philip et al, 2018;Zhang et al, 2020). It is worth noting that the answer varies between each individual, and apnea may persist in around 50% of treated babies, which can lead to some complications such as increased risk of intracranial bleeding and mortality during periods vulnerable in premature babies, in addition to increasing the need for more rigorous procedures, such as ventilation mechanics and intubation (Williamson et al, 2021;Shah, et al, 2023).…”

Developing and testing a clinical care bundle incorporating caffeine citrate to manage apnoea of prematurity in a resource-constrained setting: a mixed methods clinical feasibility study protocol

“…Caffeine citrate and aminophylline have similar therapeutic effects on respiratory function [ 4 ]. However, caffeine citrate is superior to aminophylline in improving the efficacy of supplemental oxygen, less risk of tachycardia and feeding intolerance, more reliable enteral absorption and longer half-life [ 4 , 5 ]. Recently, the WHO strongly recommended caffeine citrate for the treatment of AOP in preterm infants and the same conditionally, on shared decision-making with the parents, for the prevention of apnoea in preterm infants born before 34 weeks gestation [ 6 ].…”

“…Recently, the WHO strongly recommended caffeine citrate for the treatment of AOP in preterm infants and the same conditionally, on shared decision-making with the parents, for the prevention of apnoea in preterm infants born before 34 weeks gestation [ 6 ]. Caffeine citrate reduces the risk of AOP and its consequences, such as patent ductus arteriosus and bronchopulmonary dysplasia [ 5 , 7 , 8 ]. Additionally, neonatal caffeine therapy is associated with improved visual, motor, perceptual and spatial abilities at the attainment of the age of 11 years by averting adverse effects on intelligence, attention or behaviour, thereby demonstrating long-term safety in very low birthweight neonates [ 9 , 10 ].…”