Clincal Study Of Caffeine Citrate In The Treatment Of Primary Apnea In Prematurity

Objective To investigate the efficacy and safety of caffeine citrate in the treatment of premature infants with primary apnea by comparing the efficacy and safety of caffeine citrate,aminophylline and different doses of caffeine citrate in the treatment of premature infants with primary apnea.Methods Sixty cases of premature infants with primary apnea and caffeine citrate or aminophylline at 28-34 weeks in the Department of Neonatology,the Third Hospital of Nanchang from January 2015 to February 2018 were retrospectively analyzed,and they were divided into three groups according to their medication methods: coffee citrate group A,caffeine citrate group B and aminophylline C,20 cases in each group.The administration methods of each group were as follows:(1)Group A: loading dose of caffeine citrate 20 mg/kg,after 24 h interval,5 mg/kg maintenance dose,once every 24 hours;(2)Group B: loading dose of caffeine citrate20 mg/kg,after an interval of 24 hours,10 mg/kg maintenance dose,once every 24 hours.(3)Group C: the first dose of aminophylline was 5mg/kg,and the maintenance dose was 2 mg/kg after 12 hours,once every 12 hours.All the three groups were given drugs until 7-10 days after the disappearance of apnea.If there were still apnea episodes,the drugs should be used until the gestational age was corrected to 34 weeks.The treatment effect of apnea(apnea frequency reduced by more than 50% and apnea disappeared time after 72 hours of medication),the proportion of patients requiring mechanical ventilation,the time required for mechanical ventilation,the duration of oxygen therapy,the mortality before discharge,the incidence of BPD,PDA and ROP in 4 weeks after birth,and the failure rate of hearing screening were statistically analyzed Statistical analysis should be carried out such as increased heart rate and gastrointestinal disorders.Results 1.General information: there were no significant differences in the basic information of prenatal hormones,maternal chorioamnionitis,mode of delivery,gender,5-minute Apgar score,birth weight,gestational age and other basic conditions among the groups(all P > 0.05).2.There were significant differences in the frequency of apnea decreased by more than 50% in three groups after 72 hours of medication,and the difference was statistically significant(P < 0.05),in which caffeine citrate group B was significantly higher than aminophylline group,the difference was statistically significant(P <0.05);caffeine citrate group A was slightly higher than aminophylline group C,but the difference was not statistically significant(P > 0.05);caffeine citrate group A was slightly higher than aminophylline group C,but the difference was not statistically significant(P > 0.05);compared group A with group B,there was no significant difference(P > 0.05).3.There were significant differences in the time of complete disappearance of apnea among the three groups,and the difference was statistically significant(P <0.05).The complete disappearance time of apnea in group A and group B was shorter than that in group C.The difference between group B and group C was statistically significant(P < 0.05),but there was no significant difference between group A and group C(P > 0.05);compared group A with group B,the complete disappearance time of apnea was also significantly shortened(P < 0.05).4.The corrected gestational age at extubation in caffeine citrate group A and caffeine citrate B group was smaller than that in aminophylline group C,the differences were statistically significant(P < 0.05);there was no significant difference in corrected gestational age during extubation between group A and group B(P > 0.05).The duration of oxygen therapy in group A and group B was slightly shorter than that in group C,but the difference was not statistically significant(P >0.05).There was no significant difference in the proportion of patients requiring mechanical ventilation and mortality before discharge among the three groups(P >0.05).5.Safety: the incidence of increased heart rate,gastrointestinal disorders and hyperglycemia in group A and group B was slightly lower than that in group C,but the difference was not statistically significant(P > 0.05),and there was no significant difference in the incidence of NEC among the three groups.6.Complications: the incidence of BPD in group A and group B was slightly lower than that in group C,but the difference was not statistically significant;there was no significant difference in the incidence of PDA and ROP and the failure rate of hearing screening among the three groups(P > 0.05).Conclusion 1.Caffeine citrate is superior to aminophylline in the treatment of premature infants with apnea,including the proportion of apnea reduced by more than50% and the complete disappearance time of apnea after 72 hours of medication;2.Compared with aminophylline,caffeine citrate can shorten the use time of ventilator;3.Compared with caffeine citrate with high maintenance dose(10mg/kg)and small maintenance dose(5mg/kg),although there was no significant change in the proportion of apnea reduced by more than 50% after 72 hours of medication,but the total disappearance time of apnea was shortened,and the former was better than the latter.4.The adverse reactions of caffeine citrate were slightly lower than those of aminophylline,and the incidence of adverse drug reactions would not be increased by increasing the maintenance of caffeine citrate.Therefore,for premature infants with primary apnea,caffeine citrate is recommended as the first choice,and the maintenance dose of 10 mg/kg is better than 5mg/kg.