Caffeine Citrate Versus Aminophylline for Apnea of Prematurity: A Prospective Randomized Comparative Study

Abstract

Objective: To compare the efficacy and safety of caffeine citrate versus aminophylline in the treatment of apnea of prematurity among preterm neonates.
Study Design: Prospective randomized comparative study.
Place and Duration of Study: Department of Pediatrics, Benazir Bhutto Hospital, Rawalpindi from 4th July 2022 to 4th January 2023.
Materials and Methods: A total of 122 preterm neonates with gestational age of 34 weeks or less and at least four episodes of apnea were enrolled and randomly assigned to two groups. One group received a loading dose of 20 mg/kg of caffeine citrate followed by 10 mg/kg once daily, while the other group received a loading dose of 5 mg/kg of aminophylline followed by 2.5 mg/kg 12 hourly. The Treatment was continued for 34 weeks postmenstrual age. The primary outcome was complete resolution of apnea within 48 hours. Secondary outcomes included recurrence of apnea, changes in cardiorespiratory parameters, electrolyte stability and complications.
Results: Resolution of apnea within 48 hours occurred in 50(82%) of neonates receiving caffeine citrate compared with 40(65.6%) receiving aminophylline (p =0.040). Recurrent apnea was lower with caffeine citrate (3.3% versus 13.1%) with p value=0.048. Complications were also fewer in the caffeine group (13.1% versus 41%) with p value=0.026. Moreover, caffeine shortened NICU stay (14.2 ± 2.5 vs. 17.1 ± 3.1 days) with p value<0.001, reduced the need for mechanical ventilation (18% vs. 31%) with p value=0.035, and improved early neurodevelopmental outcomes (87% vs. 72%) with p value =0.041.
Conclusion: Caffeine citrate is superior to aminophylline, demonstrating greater effectiveness in resolving apnea, reducing complications, shortening NICU stay, decreasing the need for mechanical ventilation and promoting improved early neurodevelopmental outcomes.