| Objective:A baby whose gestational age is less than 37 weeks is referred to as premature.Apnea means breathing stops more than 20 seconds,accompanied by decreased heart rate<100/min or bruising,decreased oxygen saturation and hypotonia.Apnea of prematurity remains a major clinical problem in the neonatal intensive care unit,which may lead to a series of serious complications if prolonged.Methylxanthine is the most commonly used drug for the treatment of apnea,including citrate caffeine and theophylline.Since the introduction of caffeine citrate in China in the year 2013,theophylline has been used in China.There is not enough evidence to support the effect of caffeine treatment with citrate.The aim of this study was to,in a meta-analysis,compare clinical efficacy of caffeine citrate with that of theophylline.Methods:We systematically searched the randomized controlled trials(RCTs)comparing caffeine citrate with theophylline for apnea of prematurity in PubMed,Embase,Cochrane registry of controlled clinical trials,Sinomed,CNKI,WanFang Data and CQVIP from inception to March 31th 2016.Publication language was limited to Chinese and English.Trial quality was assessed using the modified Jadad scale and eligible data were pooled for meta-analysis.Results:Twenty-six studies were included in the meta-analysis.Therapeutic efficiency ratio at 1-3 days of theophylline was significantly higher than that of caffeine citrate(86.33%vs 64.92%,RR=1.33,P<0.00001).Mean apnea rate/100 mins at 1-3 days showed no significant differences between the two medicines(MD=-0.01,P =0.83).Incidence rate of adverse effects was significantly lower in caffeine citrate group(36.75%vs11.30%,RR=0.32,P<0.00001),especially about the tachycardia(RR = 0.20,P<0.00001),feeding intolerance(RR = 0.34,P<0.00001),fussy or irritable(RR = 0.35,P =0.0001),hyperglycaemia(RR = 0.24,P<0.0001)and hypertension(RR = 0.16,P =0.03).ConclusionsThe current study suggests that therapeutic efficiency ratio of caffeine citrate for apnea of prematurity was higher than that of theophylline.Meanwhile,caffeine citrate performed better in reducing incidence rate of adverse effects.Consequently,caffeine citrate is preferably for the treatment of apnea of prematurity. |
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