Aminophylline therapy and clinical outcomes in preterm infants

Abstract

Background: Apnea of prematurity (AOP) is a common problem in preterm infants. Methylxanthines are essential drugs used to treat AOP, with indications including prevention, treatment of apnea and facilitating extubation. Previous studies have shown a lower incidence of BPD in infants treated with methylxanthines.

Objective: To determine clinical outcomes and factors affecting clinical outcomes of aminophylline treatment in preterm infants

Method: This prospective cohort study including preterm infants ≤ 30 weeks gestation admitted to neonatal ward at Maharat Nakhon Ratchasima hospital within first 24 hours of life from May 2021 to April 2022. Clinical characteristics, indications for aminophylline treatment and clinical outcomes including effectiveness of treatment and incidence of BPD were collected. Multivariable logistic regression was used to define factors associated with effective treatment.                                                                      

Results: Seventy-eight infants received aminophylline treatment for various indications. Thirty-eight infants (48.7%) had an effective response to aminophylline treatment. Factors associated with effective treatment was gestational age (AUC =0.72, 95%CI 0.54-0.9). ROC analysis showed a cut-off value of 28.9 weeks for predicting effective aminophylline treatment. Factors associated with ineffective treatment was maximum mean airway pressure in the first 3 days ≥ 16 cmH₂O (AUC = 0.68, 95%CI 0.52-0.84).       Conclusion: The effectiveness of AOP treatment with aminophylline in preterm infants ≤ 30 weeks gestation was 48.7%. Factors associated with ineffective treatment were lower gestational age and higher maximum MAP in the first 3 days.