University of Michigan
Department of Pediatrics
Evidence-Based Pediatrics Web Site

Question

• In pre-term infants with recurrent apnea, does caffeine therapy, when compared to theophylline, treat apnea?

Clinical Bottom Lines

1. Low dose caffeine, high dose caffeine and standard dose theophylline all produce significant reduction in apneic episodes at 24 hrs.
2. High dose caffeine and theophylline showed a reduction in apnea with in 8 hrs.

Summary of Key Evidence

1. 44 infants, < 31 wks EGA, were included in this study.¹
2. Infants were randomly allocated to one of 3 treatment groups: standard dose caffeine citrate (25 mg/kg load & 6 mg/kg maint.), high dose caffeine (50 mg/kg load & 12 mg/kg maint.), theophylline (7.5 mg/kg load & 3 mg/kg TID maint.).
3. Success was defined as a greater than 50% reduction in number of apnea episodes.
4. At 48 hrs after initiating treatment 11/12 patients in standard dose caffeine group had successful reduction in apnea.
5. At 48 hrs after initiating treatment 12/12 patients in high dose caffeine group had successful reduction in apnea.  NNT = 1.25.
6. At 48 hrs after initiating treatment 12/12 patients in standard dose theophylline group had successful reduction in apnea.  NNT = 1.11

Additional Comments

• A one month supply of theophylline for a 1 kg infant costs < $1.00. A month supply of caffeine for the same infant costs approx. $88.00.

Citation

1. Scanlon JEM.  Caffeine or theophylline for neonatal apnea.  Archives of Disease in Childhood, 1992; 67:425-428.

CAT Author: Christa Arnold Shilling, MD

CAT Appraisers: Jonathan Fleigel, MD

Date appraised: February 5, 2001