ABSTRACT
Caffeine therapy reduces apnea of prematurity, promotes successful extubation from
invasive positive-pressure ventilation, and decreases the incidence of bronchopulmonary
dysplasia. The recommended dosing for caffeine is a loading dose of 20 mg/kg followed
by a 5 mg/kg/d maintenance dose. However, controversy exists about the optimal dosing
regimen and data on serum caffeine concentrations in extremely immature infants are
scant. We determined serum caffeine concentrations ~7 days after starting therapy
with a 20 or 25 mg/kg loading dose and a 6 mg/kg/d maintenance dose in 154 infants
with a mean gestational age of 29 weeks. The 25th to 75th percentile range for the
serum caffeine concentrations with the two dosing regimens was equivalent, ~18 to
23 mg/L. Within the first 14 postnatal days, the serum caffeine concentrations were
not dependent on postmenstrual age, weight, or postnatal age, and were in a range
that is safe and therapeutic. This latter observation remained valid over the ranges
of clinical and laboratory assessments of renal and hepatic functions that are usually
found in practice. Routine measurement of steady-state serum caffeine concentrations
in infants 24 to 35 weeks gestational age is not required in the absence of ongoing
apnea/hypopnea or signs compatible with toxicity.
KEYWORDS
Serum caffeine concentrations - preterm neonates
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Alastair A HutchisonM.B.Ch.B. F.R.A.C.P.
Division of Neonatology, Department of Pediatrics, The Women and Children's Hospital
of Buffalo
219 Bryant Street, Buffalo, NY 14222-2006