Controversies surrounding xanthine therapy.
The methylxanthines aminophylline, theophylline and caffeine have been used for more than 30 years to treat apnoea of prematurity. Today, they are among the most commonly prescribed drugs in neonatal medicine. Methylxanthines reduce the frequency of idiopathic apnoea and the need for mechanical ventilation by acting as non-specific inhibitors of adenosine A(1) and A(2a) receptors. However, recent and rapidly growing research into the actions of adenosine and its receptors raises concerns about the safety of methylxanthine therapy in very preterm infants. Possible adverse effects include impaired growth, lack of neuroprotection during acute hypoxic-ischaemic episodes and abnormal behaviour. An international controlled clinical trial is underway to examine the long-term efficacy and safety of methylxanthine therapy in very low birth weight babies.
Millar
David
D
Department of Paediatrics, McMaster University, 1200 Main Street West, Hamilton, Ontario, Canada L8N 3Z5.
Schmidt
Barbara
B
D000241:Adenosine / Q000627:therapeutic use; D001049:Apnea / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000009:adverse effects* / Q000627:therapeutic use*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D014665:Vasodilator Agents / Q000627:therapeutic use; D019820:Xanthine / Q000009:adverse effects* / Q000627:therapeutic use*
D000697:Central Nervous System Stimulants; D014665:Vasodilator Agents; D019820:Xanthine; D000241:Adenosine