Publication: Serum Theophylline Concentrations in very Preterm Neonates Receiving Intravenous Aminophylline for Apnea
Issued Date
2021-01-01
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ISSN
22288082
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2-s2.0-85113165267
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Mahidol University
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SCOPUS
Bibliographic Citation
Siriraj Medical Journal. Vol.73, No.8 (2021), 526-531
Suggested Citation
Pimol Wongsiridej, Sopapan Ngerncham, Siripa Usaha, Weerawadee Chandranipapongse, Tim R. Cressey, Walaiporn Bowornkitiwong Serum Theophylline Concentrations in very Preterm Neonates Receiving Intravenous Aminophylline for Apnea. Siriraj Medical Journal. Vol.73, No.8 (2021), 526-531. doi:10.33192/Smj.2021.68 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/78652
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Title
Serum Theophylline Concentrations in very Preterm Neonates Receiving Intravenous Aminophylline for Apnea
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Abstract
Objective: To determine the percentage of neonates who achieved therapeutic theophylline level (TTL) after receiving standard IV loading/maintenance aminophylline doses. To assess factors associated with achieving therapeutic theophylline concentrations and to describe adverse effects of aminophylline. Materials and Methods: This was a pilot, cross-sectional study. Preterm neonates ≤34 weeks’ gestation for which aminophylline was indicated for treatment of apnea were enrolled. Standard IV aminophylline dosage is 8 mg/ kg loading dose, followed by 1.5 mg/kg maintenance dose every 8 hours. Serum theophylline concentrations were measured prior to the 8th maintenance dose. Descriptive statistics, univariate and multivariate analyses were performed. Results: Twenty-five neonates (52% female) were enrolled: mean (standard deviation) gestational age and birth weight were 30.4 (2) weeks and 1,277 (415) grams, respectively. Aminophylline was initiated at a median (25%tile, 75%tile) postnatal age of 4 (1, 8) days. Baseline heart rate prior to the loading dose was 153 (13) beats-per-minute. Sixty percent of neonates achieved a therapeutic theophylline level. In the univariate analysis, being male and postnatal age ≤5 days were associated with successfully achieving a TTL. After adjusting for gender, postnatal age ≤5 days was the only factor associated with achieving a TTL (adjusted odds ratio 17.7, 95% confidence interval: 1.9, 164.4). Tachycardia and feeding intolerance were observed in 44% and 24% of neonates, respectively. Conclusion: Current IV aminophylline dosing conditions in Thailand achieved TTL in approximately two-thirds of neonates, suggesting therapeutic drug monitoring is beneficial for guiding dosing. A higher maintenance dose could be considered for neonates older than 5 days.