Caffeine therapy practice in the management of apnea of prematurity: National survey in Saudi Arabia

Background: Caffeine citrate is the drug of choice in management of apnea of prematurity. This study aimed to examine the current management practice of apnea of prematurity, assess the variation in the caffeine therapy use and exploring the physician's management preferences. Methods: An electronic survey was sent to physicians within the Saudi Neonatology Society database, containing questions related to the caffeine use in the management of apnea of prematurity across hospitals in Saudi Arabia. Results: The overall response rate was 53%. Both prevention and treatment of apnea of prematurity are considered the main indication for starting caffeine therapy (87%). If apnea persists while on maintenance caffeine (53%) of the respondent will increase the caffeine dose to a maximum of 10 mg/kg/dose. Discontinuing caffeine therapy is based on the corrected gestational age (78%), mostly at 34 weeks (mean 34.2 weeks [95% confidence interval [CI] 34–34.3]). If caffeine restarted for clinical indication (47%) of the respondent will give loading dose of caffeine followed by the maintenance dose. Once caffeine restarted (49%) of the respondents will continue caffeine till reaching 37 weeks corrected gestational age. Discharging patient after discontinuation of caffeine therapy generally occurs after an observation period of 5 days (82%) (mean 4.5 days [95% CI 4.2–4.9]). Conclusions: There is a considerable variation in the practice regarding caffeine use. Therefore, individual neonatal intensive care unit is encouraged to develop policies and guidelines for apnea of prematurity management, forming the foundation of a national statement to standardize management and maintain high quality of care.