A premature neonate of 28 weeks develops apnea of prematurity requiring pharmacological management. Methylxanthine therapy is initiated. Which of the following statements about caffeine citrate compared to theophylline in apnea of prematurity is CORRECT?
- A Caffeine reduces the incidence of BPD, patent ductus arteriosus, and improves long-term neurodevelopmental outcomes ✓
- B Theophylline has a wider therapeutic index than caffeine
- C Caffeine requires twice-daily dosing due to its short half-life in neonates
- D Both agents have equivalent efficacy and safety profiles in preterm neonates
Correct answer: A. Caffeine reduces the incidence of BPD, patent ductus arteriosus, and improves long-term neurodevelopmental outcomes
Explanation
The CAP (Caffeine for Apnea of Prematurity) trial demonstrated that caffeine citrate not only treats apnea effectively but also significantly reduces the incidence of BPD, decreases PDA requiring treatment, and improves neurodevelopmental outcomes at 18 months and 5 years. Caffeine has a much wider therapeutic index than theophylline. In neonates, caffeine has a very long half-life (40–230 hours) due to immature hepatic metabolism, allowing once-daily dosing. Theophylline carries higher risks of toxicity (tachycardia, seizures, GI disturbance).
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.