Apnea is a pause in breathing of greater than 20 seconds. It may occur repeatedly in preterm babies (born before 34 weeks). Methylyxanthines (such as theophylline and caffeine) are drugs that are believed to stimulate breathing efforts and have been used to reduce apnoea. It has been suggested that preterm babies with apnoea should receive prophylactic caffeine as a preventative measure.
Two small studies and one large study were identified. The two small studies enrolled infants given caffeine as a preventative measure. Neither study demonstrated any decrease in apnoea or other short term complications.
The one large study included a heterogeneous group of infants who received therapy for a variety of indications (prevention, treatment and avoidance of post-extubation apnoea of prematurity). In this overall population there was an improvement in clinical outcome at hospital discharge and developmental outcome at 18 to 21 months; however, these benefits could not be proven in the subpopulation who received prophylactic caffeine. A decrease in PDA was noted in this subpopulation.