Montealegre-Pomar Adriana, Charpak Nathalie, Lince-Rivera Catalina
Research and Projects Department, Kangaroo Foundation, Bogotá, Colombia.
Pediatrics Department, Pontifical Javeriana University, Bogotá, Colombia.
Front Pediatr. 2024 Aug 20;12:1344291. doi: 10.3389/fped.2024.1344291. eCollection 2024.
Theophylline was an orally administered xanthine used for treatment of apnea of prematurity and Bronchopulmonary Dysplasia in ambulatory follow-up of Low-Birth-Weight infants (LBWI) with oxygen-dependency in the outpatient Kangaroo Mother Care Program (KMCP). Theophylline's main metabolic product is caffeine; therefore, it was an alternative due to the frequent lack of ambulatory oral caffeine in low and middle-income countries.
To assess the effectiveness of oral theophylline in decreasing days with oxygen and to describe frequency of adverse related events.
Quasi-experiment before and after withdrawal of theophylline given systematically to LBWI with ambulatory oxygen in two KMCPs.
729 patients were recruited; period 1: 319 infants when theophylline was given routinely and period 2: 410 infants when theophylline was no longer used. The theophylline cohort had less gestational age, less weight at birth, more days in Neonatal Intensive Care Unit, more days of oxygen-dependency at KMCP admission, and more frequencies of Intrauterine Growth Restriction and apneas. After adjusting with propensity score matching, multiple linear regression showed that nutrition was associated with days of oxygen-dependency, but theophylline treatment not. No differences were found in frequencies of readmissions up to 40 weeks, intraventricular hemorrhage or neurodevelopmental problems. Participants in period 2 had more tachycardia episodes.
We did not find association between oral theophylline treatment and the reduction of days with ambulatory oxygen. For the current management of oxygen-dependency in LBW infants, the importance of nutrition based on exclusive breast feeding whenever possible, is the challenge.
在袋鼠式护理门诊项目（KMCP）中，对于低体重依赖氧气的婴儿（LBWI）进行门诊随访时，氨茶碱是一种口服的黄嘌呤类药物，用于治疗早产儿呼吸暂停和支气管肺发育不良。氨茶碱的主要代谢产物是咖啡因；因此，由于中低收入国家经常缺乏门诊口服咖啡因，它成为了一种替代药物。
评估口服氨茶碱在减少吸氧天数方面的有效性，并描述相关不良事件的发生频率。
在两个KMCP中，对系统性给予氨茶碱的低体重依赖氧气的婴儿进行撤药前后的准实验。
共招募了729名患者；第1阶段：319名婴儿常规使用氨茶碱，第2阶段：410名婴儿不再使用氨茶碱。使用氨茶碱的队列胎龄更小、出生体重更低、在新生儿重症监护病房的天数更多、在KMCP入院时依赖氧气的天数更多，以及宫内生长受限和呼吸暂停的频率更高。在进行倾向得分匹配调整后，多元线性回归显示营养与依赖氧气的天数有关，但氨茶碱治疗无关。在40周内的再入院频率、脑室内出血或神经发育问题方面未发现差异。第2阶段的参与者心动过速发作更多。
我们未发现口服氨茶碱治疗与减少门诊吸氧天数之间存在关联。对于目前低体重婴儿依赖氧气的管理，尽可能进行纯母乳喂养的营养重要性是一项挑战。
