Mike: Hello, I'm Mike Clarke, podcast editor for the Cochrane Library. An important problem for babies who are born too early is a condition called apnea and a new Cochrane review published in October 2023 brings together the evidence on the effects of a class of drugs called methylxanthines. We asked one of the authors, Matteo Bruschettini from Cochrane Sweden, to tell us about the review's findings in this podcast and he used an AI voice from elevenlabs.io to make the recording.

Matteo: Babies born too early, or preterm, especially those born after less than 28 weeks in the womb, have a higher risk of dying or having lung disease, intellectual disabilities, blindness, or deafness than babies born at or near their due date. Approximately half of all preterm babies have apnea of prematurity, which is when they stop breathing for at least 20 seconds during sleep and episodes of apnea can lead to the need for support with a breathing machine, or mechanical ventilation.
Apnea in preterm babies is commonly treated with methylxanthines – substances that are also found in tea, coffee, and chocolate. Three types of methylxanthine are caffeine, aminophylline, and theophylline, and these act as mild stimulants to speed up the body's systems and make breathing easier. Doctors give methylxanthines to babies for three main reasons: (1) to prevent apnea episodes; (2) to treat or reduce apnea episodes and thus avoid the need for mechanical ventilation; and (3) to increase the chance that babies who are on breathing machines can successfully be 'weaned' or taken off those machines and breathe on their own. In all cases, the aim is to minimize the chances of the baby developing the problems I described earlier.
In our Cochrane review, we wanted to find out if giving methylxanthines to preterm infants reduces apnea episodes and the risk of death and improves their long-term development.
We found 18 studies that involved just over 2700 preterm babies who had, or were at risk for, apnea. The biggest and longest-running study included 2006 babies from nine countries over four years, and reported on outcomes for some of the babies until they were teenagers. The remaining 17 studies were all much smaller.
The use of methylxanthine varied across the studies: six explored apnea prevention; five explored treatment; six investigated methylxanthine for weaning from breathing machines; and one study, the large one that I just mentioned, investigated methylxanthine for all 3 reasons.
Moving on to summarize our main results: giving preterm babies methylxanthines probably reduces the risk of apnea episodes and the need for breathing machines; probably increases the number who have fewer apnea episodes after 2 to 7 days; and reduces bronchopulmonary dysplasia, a form of lung injury. Finally, the large study also showed that giving methylxanthines (specifically, caffeine) improves children's development at 18 to 24 months of age.

Mike: If you would like to read the review, it's published online at Cochrane Library dot com. If you go to the website and search for 'Methylxanthine for the prevention and treatment of apnea in preterm infants' you'll see a link to it.