Prophylactic Methylxanthines for Endotracheal Extubation in Preterm Infants

Abstract

CaffeineisastimulantoftherespiratorycenterandhasbeenusedforthetreatmentofApneaofPrematurityininfantsnotrequiringmechanicalventilationortofacilitateweaningfrommechanicalventilationbystartingtherapyshortlybeforeextubation.RecentlytheuseofCaffeineinventilatedinfantshasbeeninitiatedearlierbecauseofthereportedreductioninBPD.Howeverthereispaucityofdatasupportingthispractice(EduardoBancalari,2015). Weaningfromsupportmaybeprolongedor,evenifextubationisachieved,frequentepisodesofapneamayoccurinassociationwithrespiratoryfailure(hypercarbia,hypoxaemiaandacidosis)ofsufficientseverityastoleadtoreintubationandtheuseofIPPV.Asaconsequence,theuseofIPPVisprolongedwithassociatedcostsforhigherdependencycareandapotentialformorbidityfromtheintervention(JohnWiley,2013). Whenpreterminfantshavebeengivenintermittentpositivepressureventilation(IPPV)forrespiratoryfailure,weaningfromsupportandtrachealextubationmaybedifficult.Asignificantcontributingfactoristhoughttobetherelativelypoorrespiratorydriveandtendencytodevelophypercarbiaandapnea,particularlyinverypreterminfants.Atanygivengestationalagethetendencytodevelopapneadecreaseswithincreasingpostnatalage(Henderson-Smart and Davis,2006).