Published online Nov 8, 2015. doi: 10.5409/wjcp.v4.i4.81
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.
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.