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Caffeine is a well-established treatment for apnea in premature infants. Plasma caffeine concentrations often are measured routinely during treatment even though caffeine has a relatively wide therapeutic index and its pharmacokinetics might vary, depending on an infant’s postconceptional age and other clinical factors. To determine the value of monitoring, investigators analyzed blood caffeine levels in 101 infants (postconceptional age range, 23–32 weeks) who were treated with caffeine at standard doses (20–40 mg/kg loading dose followed by 5–8 mg/kg/day). Attending neonatologists made the decisions about starting caffeine, doses, and monitoring.
Almost 95% of 231 caffeine blood levels were in the therapeutic range (5–20 mg/L), and 3% were…