Effect of Short Course Caffeine on Recurrence of Apnea of Prematurity in Preterm Infants Less than 32 Weeks: A Randomized Controlled Trial

Objectives Though caffeine is the preferred drug for apnea of prematurity for decades, the timing of discontinuation of caffeine therapy is still unknown. The proportion of ‘Recurrence of Apnea of Prematurity’(RAP) after stopping caffeine, in the short course group and long course group was compared. Methods Eligible neonates were randomized into two groups: short course group-caffeine was stopped when babies were off respiratory support and apnea free for 7 consecutive days and long course group-stopped at 34 weeks postmenstrual age (PMA) if they were off respiratory support and apnea free for 7 consecutive days. Proportion of neonates with RAP in each group was analyzed. Results There were 87 neonates in each group. The proportion of neonates with RAP was [(12.6% vs 4.6%); odds ratio (OR) 3.0 (0.92–9.8) and p = 0.06] not statistically significant between the groups. However, in the subgroup analysis of 26–28-week infants, the incidence of RAP was significantly higher (p = 0.038). Cumulative duration of therapy was less by 13.77 days in short course group babies. The incidence of intermittent hypoxemia was significantly more (p = 0.003) in short course group. The incidence of adverse effects that include feed intolerance, hyperglycemia, tachycardia, osteopenia and EUGR were also significantly more in the long course group. Conclusions There was no statistically significant difference in RAP when caffeine was discontinued earlier when compared to the long course regimen. Larger non-inferiority, multicentric trials are required particularly in extremely preterm infants to make strong recommendations on stopping therapy.