Caffeine, in the dose usualiy recommended (12-5 mg/kg loading dose and 3 mg/kg daily maintenance), and a higher dose regimen (25 mg/kg loading and 6 mg/kg daily maintenance), was compared with theophylline (7.5 mg/kg loading and 3 mg/kg thrice daily maintenance). The study was a randomised controiled trial in the treatment of a group of 44 infants of less than 31 weeks' gestation (mean gestational age 28.3 weeks) who were suffering from frequent apnoeic attacks. AU three regimens produced a significant reduction in apnoeic attacks within 24 hours, but only the higher dose caffeine and theophyfline groups showed a significant improvement in apnoea within eight hours.The use of caffeine for the treatment of neonatal apnoea is recommended, because a once daily dose is more easily administered, and because it was found that plasma concentrations were more predictable than those of theophylline. If used in very preterm infants, however, its is suggested that a higher dose regimen than that previously recommended be used to achieve a faster response. The methylxanthines-theophylline (and aminophylline) and caffeine-are widely used for the treatment of this condition.3 Theophylline has been the drug most commonly used to treat neonatal apnoea in the UK.4 5 Caffeine, however, has many potential advantages: it has a higher therapeutic ratio, it is absorbed more reliably when administered enterally and has a longer half life, thus enabling the drug to be administered only once daily.6 Caffeine has also been shown to be effective in apnoeic infants who are unresponsive to theophylline. Infants were included in our study if they were less than 31 weeks' gestation at birth and if they had either 10 (or more) apnoeic attacks in eight hours or four apnoeas in one hour. Apnoea was defined as a drop in heart rate of more than 40 beats/minute (bpm) below the resting heart rate in an infant who was not breathing, and who required stimulation to correct the problem. Infants prospectively entering the trial were randomly allocated (by random numbers in sealed envelopes) to one of three treatment groups. Group A ('standard dose caffeine')-a loading dose of 25 mg/kg caffeine citrate (12-5 mg/kg caffeine) and a maintenance dose of 6 mg/kg caffeine citrate (3 mg/kg caffeine) once daily were given to produce a desired plasma concentration of 15 mg/l caffeine (range [13][14][15][16][17][18][19][20] mg/l). Group B ('higher dose caffeine')-a loading dose of 50 mg/kg caffeine citrate (25 mg/kg caffeine) and maintenance dose of 12 mg/kg (6 mg/kg caffeine) once daily were given to produce a desired plasma concentration of 30 mg/l (range 26-40 mg/l). Group C ('theophylline')-a loading dose of 7.5 mg/kg theophylline and a maintenance dose of 3 mg/kg theophylline three times daily were given to produce a desired plasma concentration of 15 mg/l (range 13-20 mg/l). RegionalIn all three treatment groups the maintenance dose of the drug was adjusted if the plasma concentrations were out of the desired range, but in none of these patients were...

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The absorption and excretion of cefaclor were studied in 10 newborn infants. A mean peak serum concentration of 7.7 microgram/ml was achieved at 1 hour after an oral dose of 7.5 mg/kg. It is concluded that cefaclor is a well absorbed and tolerated cephalosporin for use in newborn infants.