Recurrence of apnea of prematurity following early discontinuation of caffeine: A prospective analytical study

Background There are variations in practices regarding the initiation and stopping of caffeine for apnea of prematurity among neonates above 28 weeks. Objective To estimate the proportion of recurrence of apnea of prematurity among neonates between 28 and 32 weeks on stopping caffeine after an apnea-free period of 7 days. Methodology This was a prospective, observational study conducted in a tertiary care government medical college from April 2023 to May 2024. Study population were neonates between 28 and 32 weeks gestation. Injection Caffeine citrate was started for all within 2 hours of birth and it was stopped after an apnea-free period of 7 days. Results Out of the total 300 neonates enrolled, 285 were available for primary outcome analysis. Out of the 38.2% ( n = 109) who developed recurrence of apnea, only 11.9% (CI: 8.4%–16.3%, n = 34) was due to apnea of prematurity. Late-onset sepsis was the major cause in the rest. The median day of recurrence was 7 days (IQR 3) after stopping caffeine. On multivariable logistic regression birth weight less than 1250 g was the only significant predictor for the recurrence. Conclusion The incidence of recurrence of apnea of prematurity was only 11.9 % (CI 8.4%–16.3%) among 28–32 weeks babies on early stopping of caffeine. For judicious use of caffeine, considering its cost and side effects, it may be reasonable to stop it after an apnea-free period of 7 days. Close monitoring is required for 7–10 days in babies less than 1250 g.