Apnea is a common condition in premature infants due to the immaturity of respiratory control mechanisms. Incidence increases with younger gestational age and lower birth weight, afflicting 25% of infants under 2500 g and 80% under 1000 g . Recurrent apnea can lead to respiratory failure, pulmonary hemorrhage , abnormal lung function, intracranial hemorrhage, abnormal neurodevelopment and even sudden death.
Caffeine is the most frequently used medication in the neonatal intensive care unit. It is used for the prevention and treatment of apnea, although this drug has been associated with lower incidence of bronchopulmonary dysplasia (BPD) and patent ductus arteriosus as well as intact survival at 18-21 months of life. The mechanism of action of caffeine on prevention of apnea and activation of breathing seems to be through central inhibition of adenosine receptors.
Caffeine has a long half-life of around 100 hours, thus it can be safely given once daily and has less toxicity than the other methyl xanthines. It has a wider therapeutic to toxic ratio and has reliable enteral absorption