Apnea of prematurity and caffeine pharmacokinetics: potential impact on hospital discharge

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Abstract

OBJECTIVE:

To determine the half-life of serum caffeine concentrations and its relation to apnea of prematurity (AOP) after caffeine is discontinued in preparation for hospital discharge.

STUDY DESIGN:

Prospective cohort study involving preterm infants with gestational ages ≤ 33 weeks at birth. After caffeine was discontinued, serum caffeine concentrations and electronic detection of pathologic apnea, defined a priori, were obtained at 24 and 168 h, respectively.

RESULT:

Caffeine levels decreased from 13.3 ± 3.8 to 4.3 ± 2 mg l-1 (n = 50, mean ± s.d.) at 24 and 168 h, respectively (P < 0.01). The mean caffeine half-life was 87 ± 25 h at 35 ± 1 weeks postmenstrual age. Seven days after discontinuation of caffeine, 64% of the infants had pathologic apnea.

CONCLUSION:

Hospital discharge planning for preterm infants with a history of AOP should be carefully considered after discontinuing caffeine. This study showed that caffeine may not reach subtherapeutic levels until around 11-12 days.

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