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

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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.


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.


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.


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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