To find out various clinical features associated with apnea in preterm infants

Introduction: Apnea is defined as the cessation of breathing for more than 20 seconds or any duration if associated with bradycardia and/or change in skin color (pallor or cyanosis). Apnea in preterm infants is usually related to immaturity of the central nervous system and is called apnea of prematurity (AOP). Caffeine is now used as a standard pharmacotherapy for AOP. However, the optimal dosing regimen of caffeine citrate for treatment of apnea is not well studied. We aimed to compare the efficacy and safety of high versus conventional dose caffeine on AOP.
Aims and objectives: Study to evaluate and compare therapeutic effect of high dose versus low dose caffeine citrate for treatment of apnea in preterm infants and associated clinical features and biochemical derangements.
Material and methods: A total of 54 preterm infants <35 weeks gestation, presented with AOP within the first 14 days of life were enrolled and randomized into two groups 28 in high dose group (loading 40 mg/kg/day and maintenance of 20 mg/kg/day) and 26 in conventional dose group (loading 20 mg/kg/day and maintenance of 10 mg/kg/day).
Results: Most of the neonates in our study were of 30 weeks gestational age and 1-1.2kg birth weight and exhibited apnea between 3rd-5th day of life. High-dose caffeine was associated with a significant reduction in recurrence of apnea, duration of oxygen therapy, duration of caffeine therapy and duration of NICU stay, requirement for mechanical ventilation as compared to conventional dose group. High-dose caffeine was associated with significant increase in episodes of tachycardia but this was clinically nonsignificant.
Conclusion: The use of higher, than current standard, dose of caffeine may decrease recurrence of apnea in preterm infants without significant side effects.