Caffeine in the treatment of apnea associated with respiratory syncytial virus infection in neonates and infants

Background. The xanthines have been shown to be effective in the treatment of apnea of prematurity. Limited reports are available in the literature concerning the use of these agents with apnea related to respiratory syncytial virus (RSV) infections. Methods. A retrospective review was done to identify infants who received caffeine therapy for RSV-associated apnea. The number of apneic episodes during the 2 hours before the use of caffeine and the number of apneic episodes after the administration of caffeine were compared using a Wilcoxon nonparametric test. Results. The 7 infants ranged in age from 14 to 64 days and in weight from 2.8 to 4.4 kg. The number of apneic episodes per hour for the 2 to 3 hours before the administration of caffeine ranged from 7 to 12, and the number of episodes during the 3 hours after the administration of the first dose of caffeine ranged from 0 to 2. The apneic episodes after caffeine responded to external stimulation. Apnea recurred in 3 infants, 18 to 24 hours after the first dose of caffeine. These infants received a second dose of caffeine (5 mg/kg). Conclusions. Caffeine should be considered in the treatment of apnea related to RSV infections in neonates and infants.