Cardiovascular effects of caffeine therapy in preterm infants

Article Abstract:

Premature infants sometimes receive therapy with methylxanthines, such as theophylline and caffeine, for treatment of apnea (a breathing disorder) and during removal from artificial respiration. The drug theophylline is known to increase the output of the heart's left ventricle by affecting muscle contractility and heart rate. The effects of caffeine on preterm infants have not been studied as thoroughly. Research thus far has concerned caffeine effects on the respiratory system and upon pharmacokinetics (the activity of drugs in the body). This study reports on the cardiac function and blood pressure effects of caffeine in preterm infants. Ten preterm infants received therapeutic doses of caffeine for apnea or weaning from the respirator; 10 preterm infants served as controls. All of the babies were clinically stable. Cardiac parameters that were measured included left ventricular output, stroke volume, and heart rate. Evaluations were made three times during the week-long period of therapy and again one week after treatment was discontinued. Both stroke volume and left ventricular output were significantly increased during therapy in the infants receiving caffeine compared with the controls. During the first three days of treatment, the average arterial blood pressure rose in the treatment group, but the heart rate remained unchanged. A discussion examining possible explanations for these observed effects of caffeine is presented. The cardiac changes induced by the caffeine therapy were not large, but may have significant clinical repercussions in some infants and, therefore, should be carefully considered prior to treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Complications and side effects, Heart, Caffeine, Blood pressure

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The use of primidone in neonates with theophylline-resistant apnea

Article Abstract:

The drug primidone may be effective in treating premature infants with theophylline-resistant apnea. Apnea is the absence of breathing for 20 seconds or more and affects 30% to 90% of premature infants. Apnea of prematurity is associated with immature respiratory systems or disorders such as brain hemorrhages. Sixteen premature infants with recurrent apnea despite treatment with theophylline began therapy with primidone. The average number of apneic events in the 24 hours prior to initiation of the primidone treatment was 8.7. The average number of apneic events in the three days after primidone therapy was 3.0, 2.3 and 3.0, respectively. The incidence of bradycardia, which is a slowing of the heartbeat that frequently accompanies apnea, dropped from an average of 10.1 events before primidone treatment to 3.0 following treatment.

Primidone

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Follow-up of preterm infants treated with dexamethasone for chronic lung disease

Article Abstract:

Treating premature infants suffering from chronic lung disease with dexamethasone is low-risk and of definite short-term benefit; however, long-term risks still need to be assessed before the therapy is applied to a wider population. Comparison of 61 premature infants who were treated with a course of dexamethasone and 61 who received only assisted ventilation found that the group that received the drug spent fewer days on a ventilator. The children were examined again when they were one year old. The death rate in the two groups was similar. No significant differences were found between the two groups in terms of developmental measures or number of days of hospitalization. Dexamethasone treatment has been associated with gastrointestinal bleeding and further studies are needed to determine the long-term risks of the treatment.

Analysis, Newborn infants, Dexamethasone, Respiratory therapy, Respiratory therapy for newborn infants

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