Apnea of prematurity and caffeine pharmacokinetics: potential impact on hospital discharge

Objective:to determine the half-life of serum caffeine concentrations and its relation to apnea of prematurity (aop) after caffeine is discontinued in preparation for hospital discharge.study design:prospective cohort study involving preterm infants with gestational ages ⩽33 weeks at birth. after caffeine was discontinued, serum caffeine concentrations and electronic detection of pathologic apnea, defined a priori, were obtained at 24 and 168 h, respectively.result:caffeine levels decreased from 13.3±3.8 to 4.3±2 mg l−1 (n=50, mean±s.d.) at 24 and 168 h, respectively (p<0.01). the mean caffeine half-life was 87±25 h at 35±1 weeks postmenstrual age. seven days after discontinuation of caffeine, 64% of the infants had pathologic apnea.conclusion:hospital discharge planning for preterm infants with a history of aop should be carefully considered after discontinuing caffeine. this study showed that caffeine may not reach subtherapeutic levels until around 11–12 days.