Apnoea premature infants

Apnoea in premature infants aminophylline and caffeine may benefit some cases. 

T. Lee, B. Charles, P. Steer, V. Flenady, and T. Grant, Theophylline population pharmacokinetics from routine monitoring data in very premature infants with apnoea. Br J Clin Pharmacol 41 191-200 (1996). 

Intravenous theophylline does not affect the pharmaeokinetics of doxapram given to treat apnoea in premature infants. No adjustment of the dosage of doxapram is needed in the presence of theophylline. However, the manufaeturers of doxapram say that there may be an interaction between doxapram and aminophylline or theophylline, which is manifested by agitation and increased skeletal muscle activity. Care should therefore be taken if these drugs are used together. ... 

A dose-dependent delay in sleep onset is found as well as a decrease in total sleep time and an impairment of sleep quality characterized by an increased number of spontaneous awakenings and body movements. In premature infants, sleep organization appears to be unaffected by treatment with 5 mg/ kg/day caffeine to prevent apnoea. 

The most extensively investigated and most firmly established clinical application of caffeine is the control of neonatal apnoea in premature infants. The respirogenic properties of theophylline were first reported, and caffeine is increasingly being used as a substitute for theophylline because of its wider therapeutic index. For infants with a body weight of 2.5 kg, the therapeutic loading doses varied from 5 to 30mgkg, followed by a maintenance dose of 3 mg kg per day. Plasma caffeine levels must be controlled carefully to reach 10-20 mg... 

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