When babies are born prematurely, they often have difficulty breathing due to underdeveloped lungs or throat muscles. Those who have the greatest difficulty suffer from a condition called apnea of prematurity, which is the cessation of breathing for brief periods during sleep. A medication called caffeine citrate is used to treat this condition.
Sometimes referred to as Cafcit, this compound is made by combining dried caffeine, called anhydrous caffeine, with two elements: citric acid monohydrate and sodium citrate dihydrate. The combination essentially creates a caffeine salt, which is absorbed quickly in the blood. This allows the stimulating effects of caffeine to take effect rapidly in an infant's brain, which is essential in the treatment of apnea of prematurity.
In the body of a newborn, caffeine citrate stimulates the central respiratory system and increases breathing in response to a buildup of carbon dioxide. With breathing stimulated, sleeping infants become less likely to stop breathing for short periods. Studies have shown that it is safe to administer Cafcit to premature infants aged 28 and 32 weeks.
This medication can be given to infants intravenously, by injection, or by mouth. Doctors determine the dosage based on weight and medical history. The medication should be administered at the same time each day and used for less than two weeks unless a doctor instructs otherwise.
Side effects include stomach upset and nausea, restlessness, dry skin, and rash. Some infants may have trouble sleeping while taking caffeine citrate. More serious side effects can include changes in vision and how much urine is produced. In the first three weeks of life, using this medication for apnea of prematurity also can inhibit weight gain. All observed side effects should be reported to a doctor.
Allergic reactions to caffeine citrate are rare but possible. Signs include hives and swelling of the lips, tongue, or throat. Emergency care is needed when allergic reactions are suspected.
Cafcit should not be used with some other medications, including cimetidine, ketoconazole, and phenobarbital. In addition, it’s possible that some vitamins, minerals, and other over-the-counter (OTC) products can affect the treatment. A doctor should be consulted before using any prescription or OTC products with caffeine citrate.
Premature infants metabolize caffeine more slowly than adults due to underdeveloped livers and kidneys. This means that those taking caffeine citrate should be monitored closely for possible overdoses. Symptoms of overdose, which include difficulty sleeping, constant crying, and fussiness, should be evaluated immediately.