Caffeineversusaminophylline for the prevention of apnoea of prematurity in a teaching hospital in South Africa

Abstract

Study objectives:To determine the safety and efficacy of the use of oral anhydrous caffeine and intravenous aminophylline in the neonatal population using therapeutic drug levels and clinical effects as markers for determination. Design: Prospective randomised study. Patients: Thirty-one neonates admitted (aminophylline n = 16, caffeine n = 15) with a gestational age of less than or equal to 34 weeks for prevention of apnoea of prematurity (AOP) were enrolled. Results: Oral anhydrous caffeine or intravenous aminophylline were administered using prescribed study regimens. One peak level was taken for the two drugs on day 4 of treatment 2 hours after the maintenance dose was administered. The two regimens were clinically monitored using cardiovascular, respiratory, gastro-intestinal and central nervous system parameters four hourly. The two groups did not differ significantly for gestational age (p = 0.782), birth weight (p = 1), gender (p = 0.722), and Apgar scores determined at 5 minutes (p = 0.068). Serum concentrations were within range (5-20 μg/ml) for both study groups. The median pulse rate (beats per minute) for two days; day 7: 160 vs. 148 (p = 0.019); day 9: 168 vs. 147 (p = 0.020) and median respiratory rate (breaths per minute) for five days; day 3: 68 vs. 61 (p = 0.039); day 4: 67 vs. 57 (p = 0.014); day 5: 64 vs. 58 (p = 0.045); day 7: 65 vs. 50 (p = 0.021); day 8: 66 vs. 56 p = 0.014) were significantly higher in the aminophylline study arm. Conclusion:The findings of the study indicated that caffeine is an effective alternative for intravenous aminophylline in prevention of AOP. The oral administration of caffeine may also have an advantage in a resource-poor setting.

Caffeine for the care of preterm infants in sub-Saharan Africa: a missed opportunity?

“…Most importantly, caffeine use facilitated breastfeeding and was more practical requiring no TDM. 13 This is consistent with studies in high-income settings showing advantages of caffeine over aminophylline. 7 Finally, vital sign monitoring of small sick newborn infants to identify potentially life-threatening AOP is often not feasible due to shortages of neonatal nurses and monitoring equipment.…”

A landscape evaluation of caffeine citrate availability and use in newborn care across five low- and middle-income countries

“…The dosing regimen for CC was a loading dose of 20 mg/kg/dose and a daily maintenance dose of between 5 to 10 mg/kg/day. The dosing regimen for aminophylline was a loading dose of 6 mg/kg administered intravenously (IV), followed by a maintenance dose of 2.5 mg/kg/dose/IV administered every 8 hours [ 20 – 22 ]. We interviewed three stakeholders from the Ethiopian Pharmaceutical Supply Services and one stakeholder from the Ethiopian Pediatric Society.…”