Acute hemodynamic effects of methylxanthine therapy in preterm neonates: Effect of variations in subgroups Shivakumar M, 1 Krishnananda Nayak, 2 Leslie Edward Simon Lewis, 1 Asha Kamath, 3 and Jayashree Purkayastha 1 1 Neonatology Unit, Department of Pediatrics, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal, Karnataka 576104, India 2 Department of Cardiovascular Technology, School of Allied Health Sciences, Manipal University, Madhav Nagar, Manipal, Karnataka 576104, India 3 Department of Statistics, Manipal University, Madhav Nagar, Manipal, Karnataka 576104, India Correspondence: Jayashree Purkayastha, Associate Professor, Neonatal Intensive Care Unit, Department of Pediatrics, Women and Child block, Kasturba Hospital, Manipal, Udupi, Karnataka 576104, India. Tel: þ91 9886249133. Fax: 918202571927. E-mail <jayashreepurkayastha@yahoo.com>. In-charge of prepublication contacts: Shivakumar M., Research scholar, Neonatal Intensive Care Unit, Department of Pediatrics, Women and Child block, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal, Karnataka 576104, India. Tel: þ91 9845333965. Fax: 918202571927. E-mail: <shiv.pcology@gmail.com>. ABSTRACT Background: Methylxanthines have cardiac stimulant effects. The current study aimed to compare acute hemodynamic changes between caffeine and aminophylline in 34 weeks’ preterm neonates. Methods: The study was performed using information on echocardiography measurements from preterm neonates recruited for apnea of prematurity (75 of 240) and preventing extubation failure (113 of 156) studies. The neonates were randomized either to the caffeine or aminophylline groups. Neonates with no maintenance followed by loading doses with both the methylxanthines (caffeine and aminophylline) and incomplete echocardiography examination were excluded. Results: Cardiac parameters were found to be similar between groups. The heart rate was higher among the aminophylline-treated neonates (p < 0.001) than among the caffeine-treated ones. End- systolic volume was higher among both caffeine- (p < 0.001) and aminophylline-treated neonates (p ¼ 0.001) when compared with pretreatment values. End-diastolic volume was statistically higher in both groups’ neonates (p ¼ 0.01). The odds of increase in cardiac output was higher; however, in- crease in ejection fraction was less in caffeine-treated small-for-gestation-age neonates. Conclusion: Caffeine has similar effects on cardiac parameters as aminophylline; however, caffeine- treated small-for-gestation stratification gave rise to significant cardiac variations. KEYWORDS : Apnea of prematurity, appropriate for gestation age, cardiac parameters, prevention of extubation failure, small for gestation age INTRODUCTION Methylxanthines have been used as pharmacological intervention to facilitate extubation, to prevent postextubation respiratory failure and to treat apnea of prematurity (AOP) [1, 2]. Since the report published by a multicenter Caffeine for Apnea of Prematurity V C The Author(s) [2018]. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com  264 Journal of Tropical Pediatrics, 2019, 65, 264–272 doi: 10.1093/tropej/fmy044 Advance Access Publication Date: 30 July 2018 Original paper Downloaded from https://academic.oup.com/tropej/article/65/3/264/5061536 by guest on 07 January 2023