A neonate born at 26 weeks gestation weighs 780 g and is now 36 weeks postmenstrual age. He has been on a nasal cannula at 0.5 L/min. He is observed to have 3 apnoeas per day, each requiring gentle stimulation. The most appropriate management is:

• A Discontinue caffeine as it is no longer needed at 36 weeks
• B Start theophylline instead of caffeine
• C Perform polysomnography before any intervention
• D Continue caffeine therapy until 37 weeks postmenstrual age ✓

Explanation

Caffeine therapy for apnoea of prematurity is generally continued until 37 weeks postmenstrual age (or until apnoea-free for 5–7 days), as apnoeas can persist beyond 34 weeks especially in very preterm infants. Theophylline is less preferred due to a narrower therapeutic window and more side effects. Polysomnography is not required before managing clinically apparent apnoea of prematurity. Stopping caffeine at 36 weeks when apnoeas are still occurring would be premature.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.