Apnoea of prematurity – discontinuation of methylxanthines in a resource-limited setting

Abstract

Background. Methylxanthines such as caffeine have been proven to reduce apnoea of prematurity and are often discontinued at 35 weeks’ corrected gestational age (GA).
Objective. To ascertain whether a caffeine protocol based on international guidelines is applicable in our setting, where GA is often uncertain.
Methods. A prospective folder review was undertaken of all premature infants discharged home over a 2-month period.
Results. Fifty-five babies were included. All babies born at less than 35 weeks’ GA were correctly started on caffeine as per protocol. GA was assigned in 85.5% of cases by Ballard scoring and in 14.5% from antenatal ultrasound findings. Caffeine was discontinued before 35 weeks in 54.5%.
Discussion. The main reason for discontinuing caffeine early was the baby’s ability to feed satisfactorily, a demonstration of physiological maturity. As feeding behaviours mature significantly between 33 and 36 weeks, the ability to feed may be a good indication that caffeine therapy can be stopped.