Caffeine therapy for apnea of prematurity.

Abstract

BACKGROUND:

Methylxanthines reduce the frequency of apnea of prematurity and the need for mechanical ventilation during the first seven days of therapy. It is uncertain whether methylxanthines have other short- and long-term benefits or risks in infants with very low birth weight.

METHODS:

We randomly assigned 2006 infants with birth weights of 500 to 1250 g during the first 10 days of life to receive either caffeine or placebo, until drug therapy for apnea of prematurity was no longer needed. We evaluated the short-term outcomes before the first discharge home.

RESULTS:

Of 963 infants who were assigned to caffeine and who remained alive at a postmenstrual age of 36 weeks, 350 (36 percent) received supplemental oxygen, as did 447 of the 954 infants (47 percent) assigned to placebo (adjusted odds ratio, 0.63; 95 percent confidence interval, 0.52 to 0.76; P<0.001). Positive airway pressure was discontinued one week earlier in the infants assigned to caffeine (median postmenstrual age, 31.0 weeks; interquartile range, 29.4 to 33.0) than in the infants in the placebo group (median postmenstrual age, 32.0 weeks; interquartile range, 30.3 to 34.0; P<0.001). Caffeine reduced weight gain temporarily. The mean difference in weight gain between the group receiving caffeine and the group receiving placebo was greatest after two weeks (mean difference, -23 g; 95 percent confidence interval, -32 to -13; P<0.001). The rates of death, ultrasonographic signs of brain injury, and necrotizing enterocolitis did not differ significantly between the two groups.

CONCLUSIONS:

Caffeine therapy for apnea of prematurity reduces the rate of bronchopulmonary dysplasia in infants with very low birth weight. (ClinicalTrials.gov number, NCT00182312.).

• Authors: Barbara Schmidt, Robin S Roberts, Peter Davis, Lex W Doyle, Keith J Barrington, Arne Ohlsson, Alfonso Solimano, Win Tin, Caffeine for Apnea of Prematurity Trial Group
• Journal: The New England journal of medicine (N Engl J Med) Vol. 354 Issue 20 Pg. 2112-21 (May 18 2006) ISSN: 1533-4406 [Electronic] United States
• PMID: 16707748 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright 2006 Massachusetts Medical Society.

Chemical References

• Central Nervous System Stimulants
• Caffeine

Topics

• Apnea (drug therapy, therapy)
• Bronchopulmonary Dysplasia (prevention & control)
• Caffeine (pharmacology, therapeutic use)
• Central Nervous System Stimulants (pharmacology, therapeutic use)
• Combined Modality Therapy
• Female
• Humans
• Infant, Newborn
• Infant, Premature
• Infant, Premature, Diseases (drug therapy)
• Infant, Very Low Birth Weight
• Logistic Models
• Male
• Oxygen Inhalation Therapy
• Respiration, Artificial
• Weight Gain (drug effects)