Effectiveness and Side Effects of Two Different Doses of Caffeine in Preventing Apnea in Premature Infants

Romagnoli, Costantino; Carolis, Maria Pia De; Muzii, Umberto; Zecca, Enrico; Tortorolo, Giuseppe Gio Batta; Chiarotti, Marcello; Giovanni, Nadia De; Carnevale, A.

doi:10.1097/00007691-199202000-00003

Cited by 30 publications

(26 citation statements)

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“…The risk of attrition bias was judged to be high in three studies 20 21 23. The study of Romagnoli et al 20 lacked information about randomisation, allocation concealment and blinding. The study had a high risk of incomplete data, due to a difference in included infants between the text and a table 20…”

Section: Resultsmentioning

confidence: 99%

“…*The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).† Gray et al 23: high risk of attrition bias.‡ Different definitions of high-dose and standard-dose caffeine.§ Sample size <200 events/group.¶ Romagnoli et al 20: high risk of attrition bias.** Scanlon et al 21: high risk of performance bias.† † Wide 95% CI.BPD, bronchopulmonary dysplasia; CA, corrected age; IVH, intraventricular haemorrhage ≥grade 3; NEC, necrotizing enterocolitis ≥grade 2; PMA, postmenstrual age; TRR, typical risk ratio.…”

Section: Resultsmentioning

confidence: 99%

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High versus standard dose caffeine for apnoea: a systematic review

Vliegenthart

Miedema

Hutten

et al. 2018

Arch Dis Child Fetal Neonatal Ed

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

High versus standard dose caffeine for apnoea: a systematic review

Vliegenthart

Miedema

Hutten

et al. 2018

Arch Dis Child Fetal Neonatal Ed

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“…This group also had lower theophylline plasma concentrations, which might explain the lower incidence of adverse effects. [96] Improvement in pneumogram abnormalities with resolution of clinically important apnea was observed in a study that used the higher maintenance dose of 5 mg/kg. [97] Several other studies have reported similar findings for reduction of episodes of apnea and pneumogram improvements using dosages of 2.5-5 mg/kg/day, following loading doses of 10-20 mg/kg (table I).…”

Section: Clinical Trials With Caffeinementioning

confidence: 98%

Treatment of Apnea of Prematurity

Bhatt‐Mehta

Schumacher

2003

Pediatric Drugs

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In the last decade, knowledge regarding the neurodevelopment and functional aspects of the respiratory centers during postnatal maturation has increased substantially. However, an increase in such knowledge has not provided a basis for change in practice. The diagnosis of apnea of prematurity (AOP) is one of exclusion. All causes of secondary apnea must be ruled out before initiating treatment for AOP. Treatment will depend on the etiology as well as effectiveness and tolerability of the treatment by the patient. The primary goal of any treatment of AOP is to prevent the frequency of apnea lasting >20 seconds, and/or those that are shorter, but associated with cyanosis and bradycardia. The clinical management of AOP is not much different today than it was two decades ago, with pharmacologic and nonpharmacologic treatment options remaining the mainstay of therapy. Methylxanthines are still the most widely used pharmacologic agents. Due to the wider therapeutic index of caffeine and ease of once daily administration, it should be the preferred agent. Doxapram, or nonpharmacologic treatment measures such as nasal continuous positive airway pressure, may be considered in infants who are unresponsive to methylxanthine treatment alone. Treatment should be continued until there is complete resolution of apnea, and for some time thereafter. The choice of method for weaning treatment remains one of individual physician preference. Discharge from hospital after apnea requires close monitoring and some infants will require home apnea monitors. The decision to provide a home apnea monitor should be individualized for each patient, depending on the effectiveness of treatment and clinical response.

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“…3,4 Methylxanthines effectively decrease CO 2 levels, increase O 2 consumption and improve respiratory drive in human and animal models. 5 Caffeine has a higher therapeutic ratio, is absorbed more efficiently, and desired blood levels are easier to maintain than theophylline. 6 However, both methylxanthines produce autonomic side effects in the neonate, such as tachycardia, as well as renal and CNS toxicity, neutrophil compromise and a myriad of adverse effects at higher doses.…”

Section: Introductionmentioning

confidence: 99%

Apneic preterms and methylxanthines: arousal deficits, sleep fragmentation and suppressed spontaneous movements

et al. 2007

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Objective: To determine if apneic preterm infants currently treated with methylxanthines develop evidence of sleep deprivation from cumulative arousal and motor activational effects.Study Design: Sleep, wake, arousal and actigraphic movements were monitored in extubated clinically stable premature infants (N ¼ 37). Neonates were free of other medications for >72 h and were grouped based on methylxanthine exposure: >5 days with caffeine (n ¼ 14), >5 days theophylline (n ¼ 13) or no prior exposure (n ¼ 10).Result: Duration of methylxanthine treatment predicted increased arousals, wakefulness and actigraphic movements, and decreased active sleep. Recording from 1200 to 0500 hours, methylxanthine-treated groups showed reductions in all arousal parameters: waking state, number of wake epochs, brief arousals and composite arousal index, and shorter fast-burst, sleep-related motility than untreated controls. Conclusion:In apneic preterms, chronic methylxanthine treatment appears to produce sleep deprivation secondary to the stimulatory action of methylxanthines on arousal and motor systems.

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Effectiveness and Side Effects of Two Different Doses of Caffeine in Preventing Apnea in Premature Infants

Cited by 30 publications

References 0 publications

High versus standard dose caffeine for apnoea: a systematic review

High versus standard dose caffeine for apnoea: a systematic review

Treatment of Apnea of Prematurity

Apneic preterms and methylxanthines: arousal deficits, sleep fragmentation and suppressed spontaneous movements

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