Comparative Efficacy of Theophylline and Caffeine in the Treatment of Idiopathic Apnea in Premature Infants

Brouard, Christine

doi:10.1001/archpedi.1985.02140090060028

Cited by 33 publications

(37 citation statements)

References 4 publications

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“…70 Multiple clinical trials have shown that both caffeine and theophylline are effective treatment for AOP. [71][72][73][74] Initially theophylline was the standard therapy and it required close monitoring of serum levels. Since Food and Drug Administration approval of caffeine, theophylline has been largely replaced by caffeine as the first line of management.…”

Section: Treatment Strategiesmentioning

confidence: 99%

Apnea of prematurity: pathogenesis and management strategies

Mathew

2010

J Perinatol

110

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Apnea of prematurity (AOP) is a significant clinical problem manifested by an unstable respiratory rhythm reflecting the immaturity of respiratory control systems. This review will address the pathogenesis of and treatment strategies for AOP. Although the neuronal mechanisms leading to apnea are still not well understood, recent decades have provided better insight into the generation of the respiratory rhythm and its modulation in the neonate. Ventilatory responses to hypoxia and hypercarbia are impaired and inhibitory reflexes are exaggerated in the neonate. These unique vulnerabilities predispose the neonate to the development of apnea. Treatment strategies attempt to stabilize the respiratory rhythm. Caffeine remains the primary pharmacological treatment modality and is presumed to work through blockade of adenosine receptors A 1 and A 2 . Recent evidences suggest that A 2A receptors may have a greater role than previously thought. AOP typically resolves with maturation suggesting increased myelination of the brainstem.

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Section: Treatment Strategiesmentioning

confidence: 99%

Apnea of prematurity: pathogenesis and management strategies

Mathew

2010

J Perinatol

110

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“…Caffeine has been extensively used in the treatment of apnea in premature infants, and is now being favored over theophylline in these patients [1,2], Several studies have reported extremely long elimination halflives in neonates and good absorption fol lowing oral doses [3][4][5]. Plasma concentra tions between 5 and 20 mg/1 have been found to be safe and effective [3], The rate of systemic absorption of many drugs from the gastrointestinal tract is decreased in neo nates compared to older children [6].…”

mentioning

confidence: 99%

Effect of Formula Feeding on Oral Absorption of Caffeine in Premature Infants

Giacoia¹,

Jungbluth²,

Jusko³

1989

Dev Pharmacol Ther

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The systemic absorption of orally administered caffeine was evaluated in 16 premature infants receiving therapy for recurrent apnea. An oral bolus dose of caffeine (10 mg/kg) was given during a fasted state (n = 8) or immediately preceding formula (n = 8). The first-order absorption rate constant (k(a)) was estimated from the rise in the plasma concentration- time curve and extent of absorption was estimated by the area under the concentration- time curve. Therapeutic concentrations of caffeine were achieved rapidly followed by very slow elimination of drug. No difference between the fasted and fed groups was found in the apparent rate or extent of caffeine absorption, suggesting that caffeine can be administered concomitantly with feedings.

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“…mature infants (1)(2)(3). Thus a precise knowledge of their respective adverse renal effects can be helpful for the therapeutic choice.…”

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confidence: 99%

“…In adult and experimental animals, methylxanthines act as diuretic and natriuretic agents (4), but conflicting results have been obtained in several studies assessing the renal effects of theophylline in the preterm infant (5). Moreover the renal effects of caffeine have not been extensively investigated in the neonatal period although some data suggest the absence of gross diuresis or electrolyte abnormalities (1,6). Therefore we evaluated the acute renal effects of a single dose of theophylline ethylenediamine (aminophylline, 8 1 % theophylline) or sodium benzoate caffeine in New Zealand White newborn rabbits whose renal maturation shows close similarities with that of premature infants (7).…”

mentioning

confidence: 99%

“…Therefore we evaluated the acute renal effects of a single dose of theophylline ethylenediamine (aminophylline, 8 1 % theophylline) or sodium benzoate caffeine in New Zealand White newborn rabbits whose renal maturation shows close similarities with that of premature infants (7). The methylxanthine doses were selected in the range of the usual therapeutic doses used in human neonates (1).…”

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confidence: 99%

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Renal Effects of Theophylline and Caffeine in Newborn Rabbits

Gouyon

Guignard

1987

Pediatr Res

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ABSTRACT. Renal hemodynamics and functions were assessed in four groups of anaesthetized newborn rabbits receiving a single intravenous dose of methylxanthines, i.e.:aminophylline: 3 mg/kg (Al) or 6 mg/kg (A2); sodium benzoate caffeine: 5 mg/kg (Cl) or 10 mg/kg (C2). Each animal acted as its own control. The mean PAH extraction ratio was not modified by the methylxanthines. Renal blood flow and glomerular filtration rate were determined by clearances of paraaminohippuric acid and inulin, respectively. No changes in renal hemodynamics or renal functions were observed in group Cl. In group C2, renal blood flow and filtration fraction did not vary significantly but renal vascular resistance showed a delayed increase. Systemic infusion of the two aminophylline regimens induced a delayed increase in renal vascular resistance with a concomitant fall in renal blood flow and an increase of filtration fraction in group A2. Glomerular filtration rate was either reduced (3 mg/kg aminophylline) or increased (6 mg/kg aminophylline and 10 mg/kg caffeine). Moreover, diuresis increased and tubular water reabsorption declined in groups Al, A2, and C2. High dose caffeine enhanced sodium fractional excretion. The acute renal effects of methylxanthines appeared dose-and time-related in immature animals and caffeine proved safer than aminophylline at doses used in human neonates. (Pediatr Res 21: 615-618,1987) Abbreviations V, urine flow rate GFR, glomerular filtration rate MBP, mean blood pressure RBF, renal blood flow RVR, renal vascular resistance FF, filtration fraction FENa, sodium fractional excretion PAH, para-aminohippuric acid Hct, hematocrit E PAH, renal PAH extraction ratio U/P.inulin, urine to plasma inulin ratio MX, methylxanthine PG, prostaglandinThe xanthine derivatives theophylline and caffeine are widely used and equally effective to control idiopathic apnea in pre-

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Comparative Efficacy of Theophylline and Caffeine in the Treatment of Idiopathic Apnea in Premature Infants

Cited by 33 publications

References 4 publications

Apnea of prematurity: pathogenesis and management strategies

Apnea of prematurity: pathogenesis and management strategies

Effect of Formula Feeding on Oral Absorption of Caffeine in Premature Infants

Renal Effects of Theophylline and Caffeine in Newborn Rabbits

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