Caffeine therapy for apnoea of prematurity: Pharmacological treatment

Apnoea of prematurity is among the most commonly diagnosed condiƟ ons in the newborn intensive care unit and may prolong the hospital stay of some infants. ResoluƟ on of recurrent apnoea and episodes of bradycardia and the compleƟ on of an “apnoea-free” period are generally considered to be precondiƟ ons for the discharge of premature infants without a home cardiorespiratory monitor. Caff eine is one of the drugs most commonly prescribed for premature infants. It is a potent respiratory sƟ mulant indicated primarily to reduce the incidence of episodes of apnoea associated with an immature central nervous system. It is also used frequently in these infants to facilitate weaning from mechanical venƟ laƟ on. Caff eine is presently one of the 10 most frequently prescribed medicaƟ ons in neonatal intensive care for which extensive pharmacokineƟ c data are available, parƟ cularly in the preterm neonate. Although very similar in its acƟ ons to theophylline, caff eine has several advantages and has become the preferred methylxanthine in the treatment of apnoea. Its toxicity is lower and half-life is longer, and there is less need for therapeuƟ c drug monitoring. Foetuses and newborns are exposed to caff eine via maternal intake of caff eine-containing foods and beverages. This widespread and extensive exposure to caff eine must be considered in the evaluaƟ on of the long-term eff ects of caff eine in the newborn and young infants. Despite the widespread use of caff eine for these indicaƟ ons, the evidence to support its use is based on the results of a few relaƟ vely small, short-term studies. Recently, there has been a resurgence of interest in this drug. Studies have reported some intriguing possibiliƟ es, such as the protecƟ ve eff ect of caff eine on the brain and lungs. The main goal of this paper is to present a review of the pharmacokineƟ cs of caff eine and its cellular eff ect on the physiology of newborns with apnoea.