Comparison of frequency of tachycardia of Caffeine versus Aminophylline for Apnea of Prematurity

Abstract

Background: Apnea of prematurity (AOP) is a common condition in preterm neonates, managed primarily with methylxanthines. Aminophylline has traditionally been used but is associated with adverse effects such as tachycardia. Caffeine, with a wider therapeutic index and more predictable pharmacokinetics, is increasingly preferred.  Objective: To compare the frequency of tachycardia in preterm neonates treated with caffeine versus aminophylline for apnea of prematurity. Methods: This randomized controlled trial was conducted in the Department of Pediatrics, Neonatal Intensive Care Unit (NICU), at Fauji Foundation Hospital, Lahore, from 18 January 2025 to 18 july 2025 . A total of 60 preterm neonates (<36 weeks + 7 days gestation, weight <2.5 kg) with apnea of prematurity were enrolled using non-probability consecutive sampling and randomized into two groups: Group A received aminophylline (n=30) and Group B received caffeine citrate (n=30). Results: Baseline characteristics including gestational age, birth weight, and gender were comparable between groups (p>0.05). Tachycardia occurred in 12 neonates (40.0%) in the aminophylline group compared to 3 neonates (10.0%) in the caffeine group, a statistically significant difference (p=0.01). Stratification showed higher tachycardia rates among low birth weight (<1.5 kg) and <32 weeks gestation neonates treated with aminophylline. Conclusion: Caffeine therapy is associated with a significantly lower frequency of tachycardia compared to aminophylline in preterm neonates with apnea of prematurity. These findings support caffeine as the safer first-line pharmacological therapy.