探討Caffeine Citrate治療早產兒呼吸中止之必要性

To Assess the Necessity of Caffeine Citrate Preparations for Apnea of Prematurity

林怡琇(Yi-Shiu Lin) ； 張香瑩(Sherry Hsiang-Ying Chang) ； 朱蓁蓁(Chen-Chen Chu)

《台灣醫學》 19卷1期 (2015/01) Pp. 1-8

https://doi.org/10.6320/FJM.2015.19(1).01

摘要

早產兒呼吸暫停（apnea of prematurity, AOP）為新生兒加護病房常見問題，caffeine citrate為國際上治療之首選藥品，惟國內無廠商生產，故臨床治療上仍以同屬methylxanthine類的藥品aminophylline/theophylline為治療選擇。本研究藉由分析某醫學中心AOP族群使用aminophylline的現況以及臨床文獻回顧，探討引進caffeine citrate之臨床效益。文獻回顧結果顯示caffeine citrate是美國FDA唯一適應症針對AOP的藥物，相較於aminophylline之優點包括每日單次給藥，療劑監測範圍（therapeuticrange）較廣，副作用發生機率低而安全性較高，但藥費相對較高。處方分析結果顯示aminophylline每日給藥頻次多，進行療劑監測比例高，使用於體重＜1500公克之早產兒發生疑似副作用的比例也稍高，若能專案引進或由國內廠商生產caffeine citrate，使國內治療與國際建議相符，預計可減少臨床給藥與監測頻率，降低副作用發生機率，提升早產兒用藥安全。

關鍵字

早產兒呼吸暫停 ； caffeine citrate ； theophylline ； aminophylline

並列摘要

Apnea of prematurity (AOP) is a common problem in neonate intensive care unit, and caffeine citrate is the drug of choice. Because commercial product of caffeine is not available in Taiwan, other methylxanthine derivatives, aminophylline and theophylline, are used instead. We did a retrospective study to analyze the prescribing pattern of aminophylline in AOP patients in a medical center. A literature review about clinical use of aminophylline and caffeine citrate was done to find the potential benefit of introducing the caffeine citrate. Literature review showed that caffeine citrate is the only medication indicated for AOP in U.S.FDA. Compare to the aminophylline, caffeine citrate needs only once daily dosing, has a relatively wide therapeutic range, low incidence of side effects and good safety profile, but costs higher. Prescription analysis showed that aminophylline requires multiple dosing per day, has high proportion of patients who require blood drug concentration monitoring, and has slightly higher proportion of preterm neonates weighted less than 1500 gm encountered side effects. If we can import caffeine citrate injection or have local manufacturer to produce it, the frequency of administration and monitoring, as well as the incidence of side effects may be reduced, and medication safety in premature children may be improved.

並列關鍵字

Apnea of prematurity ； caffeine citrate ； theophylline ； aminophylline

參考文獻

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