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Caffeine versus theophylline for apnea in preterm infantsSteer PA, Henderson-Smart DJ
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SummarySome evidence that caffeine is as effective as theophylline in the short term for reducing apnea in premature babies, is better tolerated and easier to give.Apnea is a pause in breathing of greater than 20 seconds. It may occur repeatedly in preterm babies (born before 34 weeks). Apnea may be harmful to the developing brain or organs if it continues. Methylxanthines (such as theophylline and caffeine) are drugs that are believed to stimulate breathing efforts and have been used to reduce apnea. The review of trials found that caffeine has similar effects to theophylline but has a larger gap between levels that are therapeutic and those with toxic effects. Caffeine is more easily absorbed and has a longer half-life that allows once daily doses.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2008 Issue 3, Copyright © 2008 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This version first published online:
April 27. 1998 AbstractBackgroundRecurrent apnea is common in preterm infants, particularly at very early gestational ages. These episodes of loss of effective breathing can lead to hypoxemia and bradycardia which may be severe enough to require resuscitation including use of positive pressure ventilation. Two forms of methylxanthine (caffeine and theophylline) have been used to stimulate breathing and so prevent apnea and its consequences. ObjectivesTo assess the effects of caffeine compared to theophylline in preterm infants with recurrent apnea. Search strategyThe standard search strategy of the Cochrane Neonatal Review Group was used. This included searches of electronic databases: Oxford Database of Perinatal Trials; Cochrane Controlled Trials Register (The Cochrane Library, Issue 3, 2002); MEDLINE (1966 - October 2002); and EMBASE Drugs and Pharmacology (1990 - October 2002), previous reviews including cross references. Selection criteriaRandomized and quasi-randomized trials comparing caffeine to theophylline for treating apnea in preterm infants. Data collection and analysisEach reviewer assessed eligibility, trial quality and extracted data separately, then compared and resolved differences. Study authors were contacted for additional information. Main resultsThree trials involving a total of 66 infants were included. The quality of these small trials was fair to good. No difference in failure rate (less than 50% reduction in apnea/bradycardia) was found between caffeine and theophylline after one to three days treatment (based on two studies) or five to seven days treatment (based on one study). Infants on caffeine showed a higher rate of apnea after one to three days treatment than those on theophylline (weighted mean difference 0.40 episodes per 100 minutes, 95% confidence interval 0.33 to 0.46, based on three studies). However no difference in apnea rate between caffeine and theophylline was found after five to seven days treatment (based on two studies). Adverse effects, indicated by tachycardia or feed intolerance leading to change in dosing, were lower in the caffeine group (relative risk 0.17, 95% confidence interval 0.04 to 0.72). This was consistent across the three studies. No trial reported the use of ventilation and no data were available to assess effects on growth and development. Authors' conclusionsCaffeine appears to have similar short term effects on apnea/bradycardia as does theophylline, although caffeine has certain therapeutic advantages over theophylline. The possibility that higher doses of caffeine might be more effective in extremely preterm infants needs further evaluation in randomized clinical trials. |