OBJECTIVE: To compare the efficacy of domestic and imported caffeine citrate in the treatment of apnea in preterm infants. METHODS: A total of 98 preterm infants with a gestational age of 28 - <34 weeks between April 2018 and December 2019 were enrolled. They were randomly administered with domestic (n=48) or imported caffeine citrate (n=50) within 6 hours after birth. The therapeutic effects, complications, adverse effects and clinical outcomes were compared between the two groups. RESULTS: There were no significant differences in the incidence of apnea within 7 days after birth, daily frequency of apnea, the time of apnea disappearance, the failure rate of intubation-surfactant-extubation strategy, the time of non-invasive assisted ventilation, the duration of oxygen therapy, the duration of caffeine citrate therapy, the length of hospital stay, blood gas analysis results, liver and kidney function testing results between the two groups (P>0.05). There were no significant differences in the incidence of complications and the mortality rate between the two groups (P>0.05). There was no significant difference in the incidence of adverse effects between the two groups (P>0.05). CONCLUSIONS The efficacy and safety of domestic caffeine citrate in the treatment of apnea are similar to those of imported caffeine citrate in preterm infants.
Apnea ; drug therapy ; Caffeine ; therapeutic use ; Citrates ; therapeutic use ; Double-Blind Method ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases ; Prospective Studies

OBJECTIVE: To study the clinical effect and safety of different maintenance doses of caffeine citrate in the treatment of apnea in very low birth weight preterm infants. METHODS: A total of 78 very low birth weight preterm infants with primary apnea were enrolled who were admitted from January 2016 to January 2018. They were randomly divided into high-dose caffeine group with 38 children and low-dose caffeine group with 40 children. Both groups received a loading dose of 20 mg/kg caffeine citrate, and 24 hours later, the children in the high-dose caffeine group were given a maintenance dose of 10 mg/kg, and those in the low-dose caffeine group were given a maintenance dose of 5 mg/kg. The two groups were compared in terms of response rate and incidence rate of adverse events. RESULTS: The high-dose caffeine group had a significantly higher response rate than the low-dose caffeine group (71% vs 48%; P<0.05). Compared with the low-dose caffeine group, the high-dose caffeine group had significantly shorter duration of apnea and time of caffeine treatment (P<0.05). There were no significant differences between the two groups in length of hospital stay and incidence rates of tachycardia, feeding intolerance, bronchopulmonary dysplasia, necrotizing enterocolitis, and intracranial hemorrhage (P>0.05). There was no significant difference in the mortality rate between the two groups (P>0.05). CONCLUSIONS Higher maintenance dose of caffeine citrate has a better clinical effect than lower maintenance dose of caffeine citrate in the treatment of apnea in very low birth weight preterm infants, without increasing the incidence rates of adverse drug reactions and serious complications in preterm infants.
Apnea ; drug therapy ; Caffeine ; therapeutic use ; Child ; Citrates ; therapeutic use ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Prospective Studies

OBJECTIVETo investigate the current status of studies on drug therapy for apnea of prematurity (AOP) in the past decade in China and abroad, and to describe the research trends in the field.

METHODSCNKI and MEDLINE were searched with the key words "apnea of prematurity" and "treatment" for articles published in the past decade (January 2006 to December 2015). The articles were screened and the key words were extracted to establish the co-occurrence matrix. Ucinet 6.2 was used to plot the knowledge map.

RESULTSA total of 26 Chinese key words and 20 English key words were included. Those in the center of the co-existent knowledge map of Chinses keywords were "preterm infants", "apnea", "primary apnea", "naloxone" and "aminophylline"; while "apnea", "preterm infants" and "caffeine" located in the central place of the co-existent knowledge map of English keywords.

CONCLUSIONSMethylxanthines are still the major drugs for AOP; however, aminophylline is mainly used in China, while caffeine is mainly used in foreign countries. Other drugs such as naltrexone are also used in the clinical treatment of AOP.

Aminophylline ; therapeutic use ; Apnea ; drug therapy ; Caffeine ; therapeutic use ; Humans ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases ; drug therapy

OBJECTIVETo evaluate the effectiveness and safety of different doses of caffeine in treatment of primary apnea in preterm infants.

METHODA total of 164 preterm infants (<32 weeks gestation), presented with primary apnea, were recruited in Tianjin Central Hospital of Gynecology and Obstetrics from October 2013 to December 2014. The patients were prospectively allocated into low-dose (loading 20 mg/kg and maintenance of 5 mg/(kg·d) after 24 h, n=82) and high-dose (loading 20 mg/kg and maintenance of 15 mg/(kg·d) after 24 h, n=82) groups of caffeine citrate treatment by using a random number table. The treatment effects, side effects of caffeine, and the clinical outcome of the preterm infants were compared between groups by χ(2) test or nonparametric test.

RESULTThe patients in low-dose group had birth weight of (1,237 ± 338) g, male gender of 43 (52%) and gestational age of (29.8 ± 3.4) weeks. The patients in high-dose group had birth weight of (1 262 ± 296) g, male gender of 45 (55%) and gestational age of (29.9 ± 2.7) weeks. The baseline characteristics including birth weight, gender and gestational age were comparable between the two groups. Frequency of apnea was significantly lower in high-dose group compared with low-dose group (10 (8, 15) vs.18 (13, 22), Z = -2.610, P = 0.009), and the success rate of removal of the ventilator was significantly higher in high-dose group compared with low-dose group (85% (70/82) vs.70% (57/82), χ(2) = 5.898, P = 0.015). The effective rate of caffeine treatment was significantly higher in high-dose group compared with low-dose group (82% (67/82) vs.61% (50/82), χ(2)=8.619, P = 0.003). No significant differences were observed concerning the incidence of caffeine-associated side effects including tachycardia, irritability, difficulty in feeding, hyperglycemia, hypertension, digestive disorders and electrolyte disturbances between two groups (P all > 0.05). There were no significant differences in the clinical outcomes of the preterm infants including death during hospitalization, chronic lung disease, other complications and duration of hospital stay between two groups (P all > 0.05).

CONCLUSIONA therapeutic regimen consisting of a loading dose of 20 mg/kg and maintenance dose of 15 mg/(kg·d) of caffeine citrate could improve the treatment effects and keep safety for primary apnea in preterm infants, and will not cause more adverse events.

Apnea ; drug therapy ; Birth Weight ; Caffeine ; administration & dosage ; Citrates ; administration & dosage ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases ; drug therapy ; Male ; Pregnancy ; Treatment Outcome

OBJECTIVETo investigate the effect of caffeine citrate treatment on early pulmonary function in preterm infants with apnea.

METHODSForty preterm infants with apnea were randomly divided into aminophylline treatment group (20 infants) and caffeine citrate treatment group (20 infants). When the preterm infants experienced apnea after birth, they were given aminophylline or caffeine citrate in addition to assisted ventilation with continuous positive airway pressure (NCPAP). After drug discontinuation, pulmonary function was measured and compared between the two groups.

RESULTSAfter treatment, compared with the aminophylline treatment group, the caffeine citrate treatment group had significantly higher tidal volume, minute ventilation volume, ratio of time to peak tidal expiratory flow to total expiratory time, ratio of volume to peak tidal expiratory flow to total expiratory volume, peak expiratory flow, and breathing flow at 75%, 50%, and 25% of tidal volume (P<0.05). The caffeine citrate treatment group had a significantly shorter time of oxygen use and NCPAP support than the aminophylline treatment group (P<0.01). Compared with the aminophylline treatment group, the caffeine citrate treatment group had a significantly lower frequency of apnea attacks (P<0.01).

CONCLUSIONSIn the treatment of apnea in preterm infants, caffeine citrate can improve early pulmonary function and reduce the incidence of apnea.

Aminophylline ; therapeutic use ; Apnea ; drug therapy ; physiopathology ; Caffeine ; pharmacology ; therapeutic use ; Citrates ; pharmacology ; therapeutic use ; Continuous Positive Airway Pressure ; Female ; Humans ; Infant, Newborn ; Infant, Premature ; Lung ; drug effects ; physiopathology ; Male

Anticoagulants ; therapeutic use ; Female ; Humans ; Male ; Pulmonary Embolism ; drug therapy ; Sleep Apnea, Obstructive ; complications ; Warfarin ; therapeutic use

Anticoagulants ; therapeutic use ; Female ; Humans ; Male ; Pulmonary Embolism ; drug therapy ; Sleep Apnea, Obstructive ; complications ; Warfarin ; therapeutic use

Secondary hypertension occurs in a significant proportion of adult patients (~10%). In young patients, renal causes (glomerulonephritis) and coarctation of the aorta should be considered. In older patients, primary aldosteronism, obstructive sleep apnoea and renal artery stenosis are more prevalent than previously thought. Primary aldosteronism can be screened by taking morning aldosterone and renin levels, and should be considered in patients with severe, resistant or hypokalaemia-associated hypertension. Symptoms of obstructive sleep apnoea should be sought. Worsening of renal function after starting an angiotensin-converting enzyme inhibitor suggests the possibility of renal artery stenosis. Recognition, diagnosis and treatment of secondary causes of hypertension lead to good clinical outcomes and the possible reversal of end-organ damage, in addition to blood pressure control. As most patients with hypertension are managed at the primary care level, it is important for primary care physicians to recognise these conditions and refer patients appropriately.
Aldosterone ; blood ; Angiotensin-Converting Enzyme Inhibitors ; therapeutic use ; Aortic Coarctation ; complications ; diagnosis ; Blood Pressure ; Glomerulonephritis ; complications ; diagnosis ; Humans ; Hyperaldosteronism ; diagnosis ; Hypertension ; complications ; diagnosis ; therapy ; Primary Health Care ; methods ; Referral and Consultation ; Renal Artery Obstruction ; drug therapy ; Renin ; blood ; Sleep Apnea, Obstructive ; complications

The use of caffeine citrate for treatment of apnea in very low birth weight infants showed short-term and long-term benefits. A systematic review and meta-analysis of the literature was undertaken to document the effect providing caffeine early (0-2 days of life) compared to providing caffeine late (> or =3 days of life) in very low birth weight infants on several neonatal outcomes, including bronchopulmonary dysplasia (BPD). We searched MEDLINE, the EMBASE database, the Cochrane Library, and KoreaMed for this meta-analysis. The quality of the included studies was assessed using the Newcastle-Ottawa Scale and Jadad's scale. Studies were included if they examined the effect of the early use of caffeine compared with the late use of caffeine. Two reviewers screened the candidate articles and extracted the data from the full-text of all of the included studies. We included a total of 59,136 participants (range 58,997-59,136; variable in one study) from a total of 5 studies. The risk of death (odds ratio [OR], 0.902; 95% confidence interval [CI], 0.828 to 0.983; P=0.019), bronchopulmonary dysplasia (BPD) (OR, 0.507; 95% CI, 0.396 to 0.648; P<0.001), and BPD or death (OR, 0.526; 95% CI, 0.384 to 0.719; P<0.001) were lower in the early caffeine group. Early caffeine use was not associated with a risk of necrotizing enterocolitis (NEC) and NEC requiring surgery. This meta-analysis suggests that early caffeine use has beneficial effects on neonatal outcomes, including mortality and BPD, without increasing the risk of NEC.
Apnea/*drug therapy ; Bronchopulmonary Dysplasia/drug therapy ; Caffeine/*administration & dosage/adverse effects ; Citrates/*administration & dosage/adverse effects ; Enterocolitis, Necrotizing/etiology ; Humans ; Infant ; Infant Mortality ; Infant, Newborn ; Infant, Very Low Birth Weight ; Risk Factors ; Treatment Outcome

PURPOSE: Sedatives must be carefully titrated for patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) as oversedation may lead to disastrous respiratory outcomes. This study aimed to investigate the relations between the effect-site concentration (Ce) of propofol and sedation and airway obstruction levels in patients with OSAHS. MATERIALS AND METHODS: In 25 patients with OSAHS, sedation was induced by 2% propofol using target-controlled infusion. Sedation and airway obstruction levels were assessed using the Observer's Assessment of Alertness/Sedation Scale and a four-category scale, respectively. The relationships between propofol Ce and sedation and airway obstruction were evaluated using a sigmoid Emax model. Pharmacodynamic modeling incorporating covariates was performed using the Nonlinear Mixed Effects Modeling VII software. RESULTS: Increased propofol Ce correlated with the depth of sedation and the severity of airway obstruction. Predicted Ce50(m) (Ce associated with 50% probability of an effect> or =m) for sedation scores (m> or =2, 3, 4, and 5) and airway-obstruction scores (m> or =2, 3, and 4) were 1.61, 1.78, 1.91, and 2.17 microg/mL and 1.53, 1.64, and 2.09 microg/mL, respectively. Including the apnea-hypopnea index (AHI) as a covariate in the analysis of Ce50(4) for airway obstruction significantly improved the performance of the basic model (p<0.05). CONCLUSION: The probability of each sedation and airway obstruction score was properly described using a sigmoid Emax model with a narrow therapeutic range of propofol Ce in OSAHS patients. Patients with high AHI values need close monitoring to ensure that airway patency is maintained during propofol sedation.
Adult ; Aged ; Airway Obstruction/*drug therapy ; Anesthesia ; Anesthetics, Intravenous/blood/pharmacokinetics/*pharmacology ; Female ; Humans ; Hypnotics and Sedatives/*pharmacology/therapeutic use ; Male ; Middle Aged ; Probability ; Propofol/*pharmacology/therapeutic use ; Sleep Apnea, Obstructive/physiopathology