Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Nov 8, 2015; 4(4): 81-93
Published online Nov 8, 2015. doi: 10.5409/wjcp.v4.i4.81
Caffeine therapy in preterm infants
Hesham Abdel-Hady, Nehad Nasef, Abd Elazeez Shabaan, Islam Nour
Hesham Abdel-Hady, Nehad Nasef, Abd Elazeez Shabaan, Islam Nour, Neonatal Intensive Care Unit, Mansoura University Children’s Hospital, Mansoura 35516, Egypt
Author contributions: All authors contributed to literature review, manuscript writing, critical review of final manuscript.
Conflict-of-interest statement: No conflict of interest is declared by any of the authors.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Hesham Abdel-Hady, Professor of Pediatrics and Neonatology, Neonatal Intensive Care Unit, Mansoura University Children’s Hospital, Gomhoria street, Mansoura 35516, Egypt.
Telephone: +2-10-05278051 Fax: +2-50-2234092
Received: March 30, 2015
Peer-review started: March 31, 2015
First decision: June 3, 2015
Revised: July 11, 2015
Accepted: August 20, 2015
Article in press: August 21, 2015
Published online: November 8, 2015

Caffeine is the most commonly used medication for treatment of apnea of prematurity. Its effect has been well established in reducing the frequency of apnea, intermittent hypoxemia, and extubation failure in mechanically ventilated preterm infants. Evidence for additional short-term benefits on reducing the incidence of bronchopulmonary dysplasia and patent ductus arteriosus has also been suggested. Controversies exist among various neonatal intensive care units in terms of drug efficacy compared to other methylxanthines, dosage regimen, time of initiation, duration of therapy, drug safety and value of therapeutic drug monitoring. In the current review, we will summarize the available evidence for the best practice in using caffeine therapy in preterm infants.

Keywords: Apnea, Caffeine, Preterm, Methylxanthines

Core tip: Caffeine is among the most commonly prescribed medications in neonatal intensive care units, it has now largely replaced other methylxanthines. Caffeine reduces the frequency of apnea, intermittent hypoxemia, facilitates extubation from mechanical ventilation, and reduces the incidence of bronchopulmonary and patent ductus arteriosus in preterm infants. There are controversies regarding the safety and efficacy of high-dose, early vs late administration, duration of therapy, value in older gestational age infants and the value of therapeutic drug monitoring.