Caffeine for treating apnea in premature babies - A literary review

Abstract

Premature infants with pulmonary complications is becoming a substantial health care problem. Apnea of prematurity being one of the biggest challenges that may end in death with no or wrongful treatment. Non-invasive respiratory support has been the favorable alternative, and caffeine citrate has been the drug of choice since the 1970s. The aim of this study was to explore how effective caffeine is for treating apnea in premature babies, but also to assess possible side effects. A systematic literature search was performed in PubMed, Embase, MEDLINE and Cochrane around mid-August of 2020. The search was based around a PICO format with the use of MeSH-terms. To begin with, 455 articles were identified, but after removing duplets and screening with advanced options (only full-text, language and year), 76 articles remained. These were skimmed superficially by the abstract, and eventually 30 articles were included in the review. Results showed that caffeine is effective in reducing and eliminating apnea episodes. It reduced BPD in VLBW preterm infants with AOP, the need of supplemental oxygen and the need for positive airway pressure. It improved survival rates without neurodevelopmental disability at 18-21 months in infants with VLBW. Caffeine therapy reduced the incidence of cerebral palsy, death and survival rates with neurodevelopmental disability. Neonates receiving caffeine at an earlier stage stayed shorter in the NICUs and were less likely to need ventilation. A side effect was temporarily reduced weight gain. Some studies showed that caffeine increased heart rate.