The Comparison of Aminophylline and Caffeine Effect on Osteopenia in Premature Infants

Apnea in premature infants with a very low birth weight is a common problem.The standard treatment with methylxanthine drugs such as aminophylline or caffeine usually continues for days and weeks in infants who need oxygen. Methylxanthines work in human models by stimulating the respiratory system through reducing the level of carbon dioxide and increasing oxygen consumption. Methylxanthine drugs have some side effects in infants such as tachycardia, renal toxicity, nervous system disturbances, neutrophilic disorders and osteopenia. Osteopenia is a common disorder seen in premature infants identified as sub-clinical. The aim of this study was to compare the effect of two drugs, aminophylline and caffeine, on the serum levels of calcium, phosphorus and alkaline phosphatase of premature neonates under methylxanthine treatment.
Material and Admitted premature infants under 32 weeks gestational age in the NICU of Alzahra Hospital in Tabriz with a need for treatment with aminophylline and caffeine were randomly divided into two groups. In the first group, 60 neonates were enrolled and were treated with aminophylline from the second day. There were 65 neonates in the second group treated with caffeine from the second day. After 45 days, serum calcium, phosphorus, and alkaline phosphatase of neonates were measured and the results were compared between the two groups.
In total, 125 premature infants including 68 males (54.4%) and 57 females (45.6%) were enrolled in the study. Bronchopulmonary dysplasia was seen at follow-up in 24 neonates (8 cases had mild and 16 moderate to severe). There was evidence of premature osteopenia in 65 cases (52%) of whom 29 were in the aminophylline group and 36 were in the caffeine group (P=0.27) No significant relationship was observed among serum calcium, phosphorus and alkaline phosphatase between the two drug groups in this study.
Based on the findings of this study, there were no significant differences in the use of aminophylline and caffeine in preterm neonates in terms of prematurity complications including osteopenia. Therefore, both caffeine and aminophylline can be used in premature infants based on need and with respect to drug accessibility. Further studies to compare the long-term effects of these two drugs are recommended.