Caffeine Citrate Therapy for Apnea of Prematurity

CAFFEINE IS A DRUG commonly used in the neonatal intensive care unit. Given its frequent use, providers need to be well informed of the drug, its indications, mechanism of action, and pharmacokinetics. Caffeine has an important history of skeptics and variable practice preference, ultimately leading to fairly new evidence supporting its pharmacologic attributes for treatment of apnea of prematurity (AOP). Caffeine is also used to stimulate preextubation respiratory drive in the nursery and following anesthesia. The purpose of this column is to review the history of methylxanthine therapy as a treatment for AOP, examine the benefits of caffeine citrate (Cafcit®) as the methylxanthine of choice, including the pharmacology and pharmacokinetics of the drug, and review the current evidence-based practice for the use of Cafcit® in the treatment of AOP.