Child Health/Methylxanthine (apnoea of prematurity)

Caffeine citrate

also: methylxanthine · apnoea of prematurity

Overview

First-line respiratory stimulant for apnoea of prematurity — improves apnoea and reduces bronchopulmonary dysplasia and cerebral palsy (CAP trial).

Mechanism

A methylxanthine that antagonises adenosine receptors (A1/A2A) → central respiratory stimulation: increased minute ventilation, CO₂ sensitivity, and diaphragmatic contractility, with fewer apnoeic episodes.

Indications

Apnoea of prematurity
Facilitating extubation in preterm infants

Adverse effects

Tachycardiacommon

Jitteriness / irritabilitycommon

Feed intolerancecommon

Toxicity: seizures, marked tachyarrhythmia (rare, wide therapeutic window)serious

Cautions & contraindications

—all

Wide therapeutic index; levels rarely needed.

Interactions

Metabolised by CYP1A2 (limited relevance in neonates — immature enzymes)

Monitoring & kinetics

Heart rate, apnoea frequency; levels only if toxicity suspected

IV/oral. Loading dose 20 mg/kg citrate → maintenance 5–10 mg/kg/day. Long neonatal half-life (once daily).

Choosing it

true

Source: BNF for Children — Caffeine citrate