Apnoea of prematurity – discontinuation of methylxanthines in a resource-limited setting

BACKGROUND: Methylxanthines such as caffeine have been proven to reduce apnoea of prematurity and are often discontinued at 35 weeks' corrected gestational age (GA). OBJECTIVE: To ascertain whether a caffeine protocol based on international guidelines is applicable in our setting, where GA is often uncertain. METHODS: A prospective folder review was undertaken of all premature infants discharged home over a 2-month period. RESULTS: Fifty-five babies were included. All babies born at less than 35 weeks' GA were correctly started on caffeine as per protocol. GA was assigned in 85.5% of cases by Ballard scoring and in 14.5% from antenatal ultrasound findings. Caffeine was discontinued before 35 weeks in 54.5%. DISCUSSION: The main reason for discontinuing caffeine early was the baby's ability to feed satisfactorily, a demonstration of physiological maturity. As feeding behaviours mature significantly between 33 and 36 weeks, the ability to feed may be a good indication that caffeine therapy can be stopped.