Apnoea in premature infants and caffeine therapy

Apnoea is one of the most common clinical manifestations in preterm infants. Apnoea of prem-aturity (AOP) is thought to be due to immaturity of cardiorespiratory control, hence it gradually improves with advancing gestational age. Methylxanthines are the mainstay of pharmacological treatment and caffeine citrate is the most commonly used therapy in current practice. This group of drugs has been administered over the last four decades despite a lack of robust evidence to support use. However, a large randomised controlled trial has now addressed the efficacy and long-term safety of caffeine therapy in preterm infants. In this article, key aspects of the patho-physiology of AOP will be highlighted and available evidence on caffeine therapy summarised.