The Therapeutic Effect Of Caffeine Citrate In Treatment And Preventing Of Primary Apnea Of Premature Infants

Objective: Part I:This part aims to explore the therapeutic effect and security of caffeine citrate and aminophylline in treatment of primary apnea of premature infants by observation the clinical effect, adverse reaction and prognosis of these two drugs treating the premature infants, and to provide the basis for the drug treatment of primary apnea of premature infants. Part II:This part aims to explore the therapeutic effect and security of caffeine citrate preventing primary apnea of preterm infants by observing the clinical effect, adverse reaction and prognosis of caffeine citrate preventing the primary apnea.Method: Part I: We selected 82 preterm infants who were diagnosed by primary apnea and met the study criterias during January, 2014 to December, 2014 admitted to neonatal department of Tianjin central hospital of obstetrics and gynecology. They were randomly divided into two groups, one was the caffeine treatment group, and the other one was the aminophylline treatment group. Caffeine treatment group were treated by caffeine with the first dose 20 mg/Kg, intravenous injection, and the maintain dose 5 mg/Kg, QD, intravenous injection after 24 hours. Aminophylline treatment group were treated by aminophylline with the first dose 5 mg/kg, intravenous injection, and the maintain dose 2 ml/kg, Q12 h, intravenous injection. Both the two groups were stopped being given drugs 7 days after the apnea disapperared. Clinical information of these cases were made a statistical analysis, incluing the incidence of apena after 48 hours of giving drugs, the incidence of BPD, PDA, intracranial hemorrhage, tachycardia, feeding intolerance and hyperglycemia, and the period of using n-CPAP during the treatment. Part II:We selected 132 preterm infants who were admitted to neonatal department of Tianjin central hospital of obstetrics and gynecology during January, 2014 to December, 2014, but the infants who had congenital malformations, sepsis and congenital heart disease were excluded. They were randomly divided into two groups, one was the caffeine group, and the other one was the control group. The caffenine group infants were intravenous injected caffeine citrate 24 hours after birth, with the first dose 20 ml/Kg, and the maintain dose 5 mg/Kg every 24 hours, until the corrected gestational age was 34 weeks. The control group were not given methylxanthine drugs. Then we compared the two group infants and made the statistical analysis, incluing the incidence of apena after 48 hours of giving drugs, the period of using n-CPAP or ventilator, theincidence of tachycardia, PDA, feeding intolerance, intracranial hemorrhage and BPD, weight growth rate and the length of hospitalization.Results: Part I: The 82 premaure infants were randomly divided into two groups. There were no statistically significant difference(P>0.05) between the caffeine treatment group and the aminophylline group in the incidence of apnea again, the duration of using n-CPAP and the incidence of BPD. But the caffeine treatment group was significantly lower than the aminophylline group in the incidence of PDA, intracranial hemorrhage, bradycardia, hyperglycemia and feeding intolerence, the results had statistical difference(P<0.05). Part II: The 132 preterm infants were randomly divided into two groups. The caffeine group was significantly lower than the control group in the incidence of apnea after 48 hours, the incidence of intracranial hemorrhage, the duration of hospitalization, and the results had statistical difference(P<0.05). There were no statistically significant difference(P>0.05) between the two groups in the incidence of BPD, bradycardia, feeding intolerence, NEC and the weight growth rate.Conculusions: 1 There were no significant difference between caffeine and aminophylline in the effect on treating the primary apnea in the premature infants. But the caffeine had effect on promoting the artery ductus closed and decreasing the incidence of intracranial hemorrage, and caffeine had lower incidence of adverse reaction than aminophylline. So caffeine is better than aminophylline in treating the primary apnea of premature infants. 2 The preterm infants who were given caffeine 24 hours after birth could reduce the incidence of the primary apnea, shorten the duration of n-CPAP, decrease the incidence of PDA 7 days after birth and intracranial hemorrage, and shorten the time of hospitalization. There was no significant adverse reaction. So the premature infants should be given caffeine for preventing the apnea 24 hours after birth, so that they can avoid the damage of each organ and system by repeated apnea, and improve the prognosis of the preterm infants.