[ScammRNC]

I am just curious as to what practice other NICU's follow around the country concerning Caffeine and Theophylline? We have used caffeine exclusively over the past 7 years, but we are getting a new medical director and she comes from a hospital that used theophylline. What's the scoop out there?

[crissrn27]

We use caffeine, we are a step-down level III, with mostly level I, or II, and our docs are pretty old school.

[Sweeper933]

We use both of them. Most of our babies just get started on the caffeine. Our babies that will (or already have) turned into the chronic respiratory kids get started on theo. Theophylline has more respiratory effects - like being a bronchodilator for one (I don't remember all the info off the top of my head). It really helps these kiddos out more than the caffeine does. Sometimes when a kid is on caffeine and still isn't making any progress (can't get off a cannula...) we will try them on theo instead. It also depends which of our attendings is on for that month, they each have their own preferences...

[BittyBabyGrower]

We use caffeine more than Theo. But with some of the kids, Theo works better, esp the BPD kids as they don't really need caffeine for a/b's anymore.

[brissie]

We use caffeine mostly, I believe the medical direcor went to it because it only has to be given once a day....

[Love_2_Learn]

We mostly use caffeine which I believe is due to the once a day dosing, fewer adverse effects, and more stable steady state plasma levels than the theophylline while having practically the same efficacy as theophylline for apnea. Also the diuretic effect of caffeine is less than with theophylline and does not have an effect on renal loss of fluid and electrolytes.

We use theophylline mostly for the babies with BPD for it's bronchodilation benefits.

Just like with theophylline we still hold the dose if the heart rate is >180 and monitor the baby for tachycardia, jitteriness, poor sleep patterns, GI upset and feeding intolerance which are the same side effects as with theophylline.