Comparing Clinical Effects Of Caffeine And Aminophylline On Preterm Infants

Background and objectives:Apnea of prematurity(AOP) caused by immature respiratory center, is defined as breathing cease for more than 20 seconds, or with bradycardia,hyoxemia or cyanopathy even less than 20 seconds. Clinical therapy of AOP includes physical stimulation, oxygen therapy, assisted ventilation and methyl xanthine drugs treatment. The most commonly used methylxanthines include caffeine citrate and aminophylline. In the past aminophylline is widely used for the treatment of AOP. In the recent decade,more and more foreign researchs about caffeine therapy for premature infants had found that caffeine was better than aminophylline both in increasing drug safety and the preventive effect of AOP,and in preventing premature complications and improving the prognosis of premature infants. While domestic drugs introduction of caffeine citrate was too late, lacking of large sample of clinical trials to estimate the clinical effects of domestic prematurity. In recent 2 years caffeine was used substituting aminophylline in a few domestic Neonatal Intensive Care Units(NICU) mostly in Three-level A-rate Hospital and rarely in district hospitals. At present, domestic reports comparing caffeine and aminophylline itherapy of premature infants was not enough, which only included a few samples, or focused on the comparison on efficacy or side effects of two kinds of drugs for AOP. More large sample clinical trials is in demand to assess comprehensively recent and long-term benefits of caffeine contrast aminophylline in clinical application in preterm infants, including comparative analysis of curative effect of two drugs on AOP, the effect of ventilation and hospitalization time, impacts on the incidence of respiratory complications and other complications of premature infants, which is important for guiding clinical treatment. In addition, the current focus of abroad is whether the timing of caffeine medication effecting on clinical outcomes in preterm infants. While the domestic caffeine treatment started later, treatment with standard dose regimen of FDA released, and caffeine application timing in clinical practice differs obviously. This article reviews the clinical application of the caffeine citrate and aminophylline in preterm infants, provide evidence for clinical randomized controlled trials of large sample. Methods:This study selected 176 cases of preterm infants hospitalized in the first Bethune hospital of Jilin university NICU from November 2013 to February 2016. The cases were divided into two groups according to the drug category, 94 cases of caffeine group(group C) and 82 cases of aminophylline group(group A) respectively. Design a questionnaire, gather informations of the selected infants from case history medical records system, collate and calculate the basical datas to compare the effects of caffeine and aminophylline on the treatment of AOP, impacts on respiratory system and other short-term prognosis,and the side effects of the two kinds of drugs. Results:The situation of the infants in C group and A group had no significant difference. Comparing the effect on AOP : AOP recurrence after drugs discontinuation,there’s 20 cases of C group,42 cases of A group; upregulation of respiratory support,2 cases of C group,10 cases of A group,the difference between the two groups was statistically significant. Effects on respiratory support time and length of stay: compared with the A group, the average hospital stay in group C was reduced by 9.64 days, and the post-menstrual Age(PMA) was reduced by 0.64 weeks, and the mean time of oxygen-evacuation PMA was decreased by 0.87 weeks.,and the inter-hospital costs were almostly saved ￥11 767.75 yuan.The difference was statistically significant respectively.The incidence of severe BPD and severe retinopathy of prematurity detection rate, incidence of encephalopathy, infection rate, C group was significantly lower than the A group, there were statistically significant. Bronchopulmonary dysplasia rate, the incidence of patent ductus arteriosus need-treatment rate, the detection rate of ROP, intraventricular hemorrhage incidence and rate of severe IVH, necrotizing enterocolitis incidence, the incidence of anemia and the proportion of blood transfusion therapy, the two groups had no significant difference. The side-effects of Group C were significantly lower than Group A. Conclusion:1. Caffeine which had more slightly side-effects superior to aminophylline reduced the recurrence rate of AOP recurrence and upregulation of respiratory supports.2. Caffeine reduced the average hospitalization days in preterm infants and the PMA when oxygen is stopped than aminophyline.3. Caffeine reduced the severity of BPD and ROP of preterm infants.4. Caffeine lowed the incidence of encephalopathy and the incidence of infection of preterm infants.