Comparison between Caffeine and Theophylline Therapy for Apnea of Prematurity

Purpose: Methylxanthines are commonly used to treat apnea of prematurity. Recent studies have reported that caffeine therapy reduces the rate of bronchopulmonary dysplasia (BPD) and improves the rate of survival in preterm infant without neuro­ developmental disabilities. This study was performed to compare the effects on apnea episodes, adverse effects and morbidity between the caffeine and theophylline groups. Methods: A retrospective study was performed in 143 infants born at less than 33 weeks of gestation and treated with caffeine (n=54) or theophylline (n=89) from 2011 to 2012. The baseline characteristics of mothers and their infants were examined. The number of apnea events before and after treatment, the duration of respiratory support, and the rate of re­intubation were compared. Furthermore, adverse effects, clinical course, and morbidities such as BPD and periventricular leukomalacia were compared before discharge. Results: There were no significant differences in the baseline characteristics. Theo­ phylline and caffeine appeared to have similar short­term therapeutic advantages on apnea of prematurity in mean apnea rate after first two weeks of treatment. However, there were no statistically significant differences in the duration of respi­ ratory support, rate of re­intubation, clinical course, and morbidity between the two groups. Adverse effects, indicated by feeding intolerance were lower in the caffeine group. Conclusion: Caffeine was as effective as theophylline in the short­term for reducing apnea in preterm babies and was better tolerated and was easier to administer. A prospective randomized study is needed to confirm the effect of caffeine on the lone­ term neuro developmental outcome in prema turity.