Through this action it modulates many neurotransmitters, such as noradrenaline, dopamine, serotonin, acetylcholine, glutamine, and gamma-aminobutyric acid. Caffeine also stimulates the central nervous and cardiovascular systems, enhances catecholamine secretion, has a diuretic effect, and alters glucose homeostasis.Ĭaffeine acts as a selective adenosine antagonist at the A2a receptors and a non-selective adenosine antagonist at A1 receptor. The pharmacological effects of caffeine in AOP include: (1) stimulation of the respiratory center in the medulla (2) increased sensitivity to carbon dioxide (3) increased skeletal muscle tone (4) enhanced diaphragmatic contractility (5) increased minute ventilation (6) increased metabolic rate and (7) increased oxygen consumption. Moreover, methylxanthines increase the success of extubation of preterm infants within 1 wk of age. Cost-effectiveness analysis showed caffeine to be both cost-saving and beneficial. Many NICUs have changed their practice toward earlier initiation of caffeine therapy. A recent study, demonstrated that early caffeine initiation is associated with reduced neonatal morbidity, including a decreased incidence of BPD and of patent ductus arteriosus (PDA) requiring treatment in very low-birth-weight (VLBW) infants. By 5 years of age, the reduction in rates of cerebral palsy with caffeine treatment was no longer statistically significant, but the gross motor function improved and the incidence of developmental coordination disorder was reduced. Approximately one-half of this neuroprotective effect was attributed to improved respiratory morbidity, including an approximate 1 wk reduction in the duration of mechanical ventilation.
On follow-up at 18 mo, they had a lower incidence of cerebral palsy and cognitive delay. In the pioneering study “Caffeine for Apnea of Prematurity (CAP) trial”, infants who received caffeine had a lower incidence of bronchopulmonary (BPD) and severe retinopathy of prematurity (ROP). Caffeine has now largely replaced theophylline and aminophylline for treatment of AOP because of its wider therapeutic index and longer half-life that allows once daily administration. They have been used for the treatment of apnea of prematurity (AOP) over the past 40 years. Methylxanthines are among the most commonly used medications in preterm infants.
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