Caffeine for Apnea of Prematurity
Marianna Parker
Sara V. Bates
Caffeine Therapy for Apnea of Prematurity
Schmidt B, Roberts RS, Davis P, et al. N Engl J Med. 2006;354(20):2112–2121
Background
Apnea of prematurity (AOP) commonly occurs in infants born at <34 weeks’ gestation. Methylxanthines (caffeine, aminophylline, theophylline) have been used for over 40 years to reduce frequency of AOP and need for mechanical ventilation in the first week. This study sought to delineate the benefits and risks of caffeine therapy in preterm neonates.
Objectives
To determine the short- and long-term efficacy and safety of caffeine therapy in very low-birth-weight (VLBW) newborns.
Methods
Double-blind, randomized, placebo-controlled trial at multiple centers in the US, Canada, Australia, Europe, and Israel from 1999 to 2004.
Patients
2,006 infants with birth weights between 500 and 1,250 g who were considered candidates for caffeine therapy during the first 10 days of life. Select exclusion criteria: congenital anomalies with significant morbidity, previous methylxanthine treatment.
Intervention
Comparison of placebo to intervention of caffeine citrate (loading dose 20 mg/kg followed by maintenance 5 mg/kg/d and weekly weight adjustment). Maintenance dose could be increased to 10 mg/kg/d for persistent apnea. Dose was held or reduced if concern for caffeine-induced toxicity.
