Caffeine versus aminophylline in combination with oxygen therapy for apnea of prematurity: A retrospective cohort study

Zhang,Cheng-Yun; Liu,Dong‑Jie; Hua,Shao-Dong; Guo,Shan; Li,Xiao-Yan; Zhang,Bing; An,Li-Hua

doi:10.3892/etm.2020.9175

Caffeine versus aminophylline in combination with oxygen therapy for apnea of prematurity: A retrospective cohort study

Authors:
- Cheng-Yun Zhang
- Dong‑Jie Liu
- Shao-Dong Hua
- Shan Guo
- Xiao-Yan Li
- Bing Zhang
- Li-Hua An
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Affiliations: Department of Neonatology, The First People's Hospital of Zhengzhou City, Zhengzhou, Henan 450000, P.R. China, Newborn Intensive Care Unit, The Seventh Medical Center of The Chinese People's Liberation Army, Affiliated Bayi Children's Hospital, Beijing 100700, P.R. China, Department of Obstetrics, The First People's Hospital of Zhengzhou City, Zhengzhou, Henan 450000, P.R. China
Published online on: September 3, 2020 https://doi.org/10.3892/etm.2020.9175
Article Number: 46
Copyright: © Zhang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The present study was conducted to investigate the clinical significance of caffeine and aminophylline in the treatment of premature infants with apnea under varying conditions of oxygen (O₂) delivery. The clinical data of 120 premature infants with apnea treated with oxygen therapy and either caffeine citrate (20 mg/kg/day; n=77) or aminophylline (10 mg/kg/day; n=43) were retrospectively examined. The therapeutic performance of the drugs after the completion of the treatment was evaluated primarily according to the risk of recurrent episodes of apnea, the changes in the duration and concentration of inhaled O₂ and the incidence of complications. In contrast to aminophylline, caffeine treatment significantly reduced the duration of O₂ inhalation and the inhaled O₂ concentration in the infants treated with mechanical ventilation or O₂ delivery devices (P<0.05). Treatment with caffeine also decreased the incidence of recurrent apnea events and complications in the investigated population (P<0.05 or P<0.01). Caffeine performs better than aminophylline in the treatment of premature infants with apnea under different conditions of O₂ delivery. The therapeutic performance of caffeine is achieved primarily via improving the efficacy of supplemental O₂ and reducing the incidence of complications.

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1	Schmidt B, Roberts RS, Davis P, Doyle LW, Barrington KJ, Ohlsson A, Solimano A and Tin W: Caffeine for Apnea of Prematurity Trial Group. Caffeine therapy for apnea of prematurity. N Engl J Med. 354:2112–2121. 2006.PubMed/NCBI View Article : Google Scholar
2	Pillekamp F, Hermann C, Keller T, von Gontard A, Kribs A and Roth B: Factors influencing apnea and bradycardia of prematurity-implications for neurodevelopment. Neonatology. 91:155–161. 2007.PubMed/NCBI View Article : Google Scholar
3	Ducrocq S, Biran-Mucignat V, Boelle PY, Lebas F, Baudon JJ and Gold F: Apnea of prematurity: Risk factors and ambulatory treatment with caffeine citrate. Arch Pediatr. 13:1299–1304. 2006.PubMed/NCBI View Article : Google Scholar : (In French).
4	Martin RJ, Abu-Shaweesh JM and Baird TM: Apnoea of prematurity. Paediatr Respir Rev. 5 (Suppl A):S377–S382. 2004.PubMed/NCBI View Article : Google Scholar
5	Siu A and James A: Apnea of prematurity pharmacotherapy. US Pharm. 35:HS2–HS6. 2010.
6	Janvier A, Khairy M, Kokkotis A, Cormier C, Messmer D and Barrington KJ: Apnea is associated with neurodevelopmental impairment in very low birth weight infants. J Perinatol. 24:763–768. 2004.PubMed/NCBI View Article : Google Scholar
7	Zhao J, Gonzalez F and Mu D: Apnea of prematurity: From cause to treatment. Eur J Pediatr. 170:1097–1105. 2011.PubMed/NCBI View Article : Google Scholar
8	Henderson-Smart DJ and De Paoli AG: Methylxanthine treatment for apnoea in preterm infants. Cochrane Database Syst Rev: CD000140, 2010.
9	Pantalitschka T, Sievers J, Urschitz MS, Herberts T, Reher C and Poets CF: Randomised crossover trial of four nasal respiratory support systems for apnoea of prematurity in very low birthweight infants. Arch Dis Child Fetal Neonatal Ed. 94:F245–F248. 2009.PubMed/NCBI View Article : Google Scholar
10	Lemyre B, Davis PG and de Paoli AG: Nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for apnea of prematurity. Cochrane Database Syst Rev: CD002272, 2002.
11	Koch G, Datta AN, Jost K, Schulzke SM, van den Anker J and Pfister M: Caffeine citrate dosing adjustments to assure stable caffeine concentrations in preterm neonates. J Pediatr. 191:50–56.e1. 2017.PubMed/NCBI View Article : Google Scholar
12	Schoen K, Yu T, Stockmann C, Spigarelli MG and Sherwin CM: Use of methylxanthine therapies for the treatment and prevention of apnea of prematurity. Paediatr Drugs. 16:169–177. 2014.PubMed/NCBI View Article : Google Scholar
13	Brown MK and DiBlasi RM: Mechanical ventilation of the premature neonate. Respir Care. 56:1298–1313. 2011.PubMed/NCBI View Article : Google Scholar
14	Reyes ZC, Claure N, Tauscher MK, D'Ugard C, Vanbuskirk S and Bancalari E: Randomized, controlled trial comparing synchronized intermittent mandatory ventilation and synchronized intermittent mandatory ventilation plus pressure support in preterm infants. Pediatrics. 118:1409–1417. 2006.PubMed/NCBI View Article : Google Scholar
15	Shi Y, Tang S, Zhao J and Shen J: A prospective, randomized, controlled study of NIPPV versus nCPAP in preterm and term infants with respiratory distress syndrome. Pediatric Pulmonology. 49:673–678. 2014.PubMed/NCBI View Article : Google Scholar
16	Arlettaz R: Echocardiographic evaluation of patent ductus arteriosus in preterm infants. Front Pediatr. 5(147)2017.PubMed/NCBI View Article : Google Scholar
17	Gien J and Kinsella JP: Pathogenesis and treatment of bronchopulmonary dysplasia. Curr Opin Pediatr. 23:305–313. 2011.PubMed/NCBI View Article : Google Scholar
18	Coursey CA, Hollingsworth CL, Wriston C, Beam C, Rice H and Bisset G III: Radiographic predictors of disease severity in neonates and infants with necrotizing enterocolitis. AJR Am J Roentgenol. 193:1408–1413. 2009.PubMed/NCBI View Article : Google Scholar
19	Fierson WM: AMERICAN ACADEMY OF PEDIATRICS Section on Ophthalmology; AMERICAN ACADEMY OF OPHTHALMOLOGY; AMERICAN ASSOCIATION FOR PEDIATRIC OPHTHALMOLOGY AND STRABISMUS; AMERICAN ASSOCIATION OF CERTIFIED ORTHOPTISTS. Screening examination of premature infants for retinopathy of prematurity. Pediatrics. 142(e20183061)2018.PubMed/NCBI View Article : Google Scholar
20	O'Shea TM, Allred EN, Kuban KC, Hirtz D, Specter B, Durfee S, Paneth N and Leviton A: ELGAN Study Investigators. Intraventricular hemorrhage and developmental outcomes at 24 months of age in extremely preterm infants. J Child Neurol. 27:22–29. 2012.PubMed/NCBI View Article : Google Scholar
21	Stokowski LA: A primer on Apnea of prematurity. Adv Neonatal Care. 5:155–170; quiz 171-174. 2005.PubMed/NCBI View Article : Google Scholar
22	Aranda JV, Beharry K, Valencia GB, Natarajan G and Davis J: Caffeine impact on neonatal morbidities. J Matern Fetal Neonatal Med. 23:20–23. 2010.PubMed/NCBI View Article : Google Scholar
23	Henderson-Smart DJ and Steer PA: Caffeine versus theophylline for apnea in preterm infants. Cochrane Database Syst Rev. 20(CD000273)2010.PubMed/NCBI View Article : Google Scholar
24	Mueni E, Opiyo N and English M: Caffeine for the management of apnea in preterm infants. Int Health. 1:190–195. 2009.PubMed/NCBI View Article : Google Scholar
25	Donn SM and Sinha SK: Minimising ventilator induced lung injury in preterm infants. Arch Dis Child Fetal Neonatal Ed. 91:F226–F230. 2006.PubMed/NCBI View Article : Google Scholar
26	Rocha G, Soares P, Gonçalves A, Silva AI, Almeida D, Figueiredo S, Pissarra S, Costa S, Soares H, Flôr-de-Lima F and Guimarães H: Respiratory care for the ventilated neonate. Can Respir J. 2018(7472964)2018.PubMed/NCBI View Article : Google Scholar
27	Garg S and Sinha S: Non-invasive ventilation in premature infants: Based on evidence or habit. J Clin Neonatol. 2:155–159. 2013.PubMed/NCBI View Article : Google Scholar
28	Deschamp A and Daftary A: A newborn infant with oxygen desaturation during sleep. Chest. 151:e17–e20. 2017.PubMed/NCBI View Article : Google Scholar
29	Dobson NR and Patel RM: The role of caffeine in non-invasive respiratory support. Clin Perinatol. 43:773–782. 2016.PubMed/NCBI View Article : Google Scholar
30	Abdel-Hady H, Nasef N, Shabaan AE and Nour I: Caffeine therapy in preterm infants. World J Clin Pediatr. 4:81–93. 2015.PubMed/NCBI View Article : Google Scholar
31	Owen LS, Manley BJ, Davis PG and Doyle LW: The evolution of modern respiratory care for preterm infants. Lancet. 389:1649–1659. 2017.PubMed/NCBI View Article : Google Scholar
32	Kieran EA, Walsh H and O'Donnell CP: Survey of nasal continuous positive airways pressure (NCPAP) and nasal intermittent positive pressure ventilation (NIPPV) use in Irish newborn nurseries. Arch Dis Child Fetal Neonatal Ed. 96(F156)2011.PubMed/NCBI View Article : Google Scholar
33	Lemyre B, Laughon M, Bose C and Davis PG: Early nasal intermittent positive pressure ventilation (NIPPV) versus early nasal continuous positive airway pressure (NCPAP) for preterm infants. Cochrane Database Syst Rev. 12(CD005384)2016.PubMed/NCBI View Article : Google Scholar
34	Chakraborty M and Kotecha S: Pulmonary surfactant in newborn infants and children. Breathe. 9:476–488. 2013.
35	Jobe AH: The new bronchopulmonary dysplasia. Curr Opin Pediatr. 23:167–172. 2011.PubMed/NCBI View Article : Google Scholar
36	Muza RT: Central sleep apnoea-a clinical review. J Thorac Dis. 7:930–937. 2015.PubMed/NCBI View Article : Google Scholar
37	Bancalari E: Caffeine for apnea of prematurity. N Engl J Med. 354:2179–2181. 2006.
38	Kassim Z, Greenough A and Rafferty GF: Effect of caffeine on respiratory muscle strength and lung function in prematurely born, ventilated infants. Eur J Pediatr. 168:1491–1495. 2009.PubMed/NCBI View Article : Google Scholar
39	Clark RH, Bloom BT, Spitzer AR and Gerstmann DR: Reported medication use in the neonatal intensive care unit: Data from a large national data set. Pediatrics. 117:1979–1987. 2006.PubMed/NCBI View Article : Google Scholar
40	Stevenson DK: On the Caffeination of Prematurity. N Engl J Med. 357:1967–1968. 2007.PubMed/NCBI View Article : Google Scholar
41	April J, Ekta P, Kyle C, Jreisat C, Kampanatkosol R and Sajous C: Does early caffeine therapy effect patent ductus arteriosus outcomes in very low birth weight infants? Acad J Ped Neonatol. 4(555696)2017.
42	Lodha A, Entz R, Synnes A, Creighton D, Yusuf K, Lapointe A, Yang J and Shah PS: investigators of the Canadian Neonatal Network (CNN) and the Canadian Neonatal Follow-up Network (CNFUN). Early caffeine administration and neurodevelopmental outcomes in preterm infants. Pediatrics. 143(e20181348)2019.PubMed/NCBI View Article : Google Scholar
43	Bairam A, Uppari N, Mubayed S and Joseph V: An overview on the respiratory stimulant effects of caffeine and progesterone on response to hypoxia and apnea frequency in developing rats. Adv Exp Med Biol. 860:211–220. 2015.PubMed/NCBI View Article : Google Scholar