Ye Chaohui, Miao Caiyun, Yu Li, Dong Zhuoya, Zhang Jie, Mao Yingying, Lu Xiaodong, Lyu Qin
Department of Pharmacy, Ningbo Women & Children Hospital, Ningbo 315012, Zhejiang, China.
Department of Pharmacy, The Affiliated Hospital of Medical School of Ningbo University, Ningbo 315020, Zhejiang, China.
Pediatr Neonatol. 2019 Feb;60(1):43-49. doi: 10.1016/j.pedneo.2018.03.008. Epub 2018 Mar 30.
The factors affecting the safety and efficacy of aminophylline use in the treatment of apnea of prematurity (AOP) in the neonatal intensive care unit (NICU) are not clear. In this study, we aimed to evaluate the potential factors affecting the efficacy and safety of aminophylline in AOP treatment at standard doses and to determine appropriate patients for this therapy.
Over a 3-year period (January 2012 to December 2014), the medical records of 206 preterm infants with apnea who were admitted to the NICU of our hospital to receive aminophylline infusions were retrospectively reviewed. These infants were subjected to routine theophylline monitoring by reversed-phase high performance liquid chromatography. The primary outcome measures were the efficacy of aminophylline treatment and adverse reactions observed upon administration.
One-hundred and twenty-seven (61.65%) infants were considered to have undergone effective therapy and classified accordingly. Gestational age, body weight at the initiation of aminophylline, and serum theophylline concentration were identified as protective factors of therapeutic efficacy. Receiver operating characteristic (ROC) analysis indicated cutoff values of 30.36 weeks for gestational age and 1.69 kg for body weight at initiation of aminophylline administration for ensuring high efficacy of aminophylline for AOP. Fifty-three (25.73%) infants had adverse reactions. Birth weight and serum concentration of theophylline were associated with an increased risk of adverse reactions, with odds ratios of 0.167 and 1.346, respectively. The ROC curves indicated a birth weight cutoff value of 1.48 kg.
Infants with apnea and gestational age >30.36 weeks, body weight at initiation of aminophylline treatment above 1.69 kg, and birth weight >1.48 kg are suitable for treatment with aminophylline. Monitoring of serum theophylline concentration should be implemented in the absence of clinical response or in case of suspected adverse reactions.
在新生儿重症监护病房（NICU）中，影响氨茶碱用于治疗早产儿呼吸暂停（AOP）安全性和有效性的因素尚不清楚。在本研究中，我们旨在评估影响标准剂量氨茶碱治疗AOP有效性和安全性的潜在因素，并确定适合该治疗的患者。
在3年期间（2012年1月至2014年12月），对我院NICU收治的206例接受氨茶碱输注的呼吸暂停早产儿的病历进行回顾性分析。这些婴儿通过反相高效液相色谱法进行常规茶碱监测。主要观察指标为氨茶碱治疗的有效性和给药时观察到的不良反应。
127例（61.65%）婴儿被认为接受了有效治疗并据此分类。胎龄、开始使用氨茶碱时的体重以及血清茶碱浓度被确定为治疗效果的保护因素。受试者工作特征（ROC）分析表明，为确保氨茶碱对AOP的高疗效，开始使用氨茶碱时胎龄的截断值为30.36周，体重为1.69 kg。53例（25.73%）婴儿出现不良反应。出生体重和血清茶碱浓度与不良反应风险增加相关，比值比分别为0.167和1.346。ROC曲线表明出生体重截断值为1.48 kg。
胎龄>30.36周、开始氨茶碱治疗时体重>1.69 kg且出生体重>1.48 kg的呼吸暂停婴儿适合用氨茶碱治疗。在无临床反应或怀疑有不良反应时，应监测血清茶碱浓度。
