Cochrane · systematic review · CD013830
Methylxanthine for the prevention and treatment of apnea in preterm infants
Marques, KA, Bruschettini, M, Roehr, CC, et al. · Cochrane Database of Systematic Reviews · 2023 · Cochrane Library
NeonatalAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
33
current version
GRADE rated
29
No studies
4
Included studies
NR
No studies 4 · 12.1%Ungraded 0 · 0%Very low 2 · 6.1%Low 6 · 18.2%Moderate 20 · 60.6%High 1 · 3%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Methylxanthine compared to placebo or control for any indication in preterm infants
Population: preterm infants at risk of or with apnea; preterm infants undergoing extubation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death or major neurodevelopmental disability at 18 to 24 months Methylxanthine vs placebo or control | RR 0.87 [0.78, 0.97] | 1 study · 1869 participants | Moderate Downgraded: imprecision |
Death at hospital discharge Methylxanthine vs placebo or control | RR 0.99 [0.71, 1.37] | 7 studies · 2289 participants | Moderate Downgraded: imprecision |
Major neurodevelopmental disability at 18 to 24 months Methylxanthine vs placebo or control | RR 0.85 [0.76, 0.96] | 1 study · 1869 participants | Moderate Downgraded: imprecision |
a) Cerebral palsy or gross motor disability Methylxanthine vs placebo or control | RR 0.6 [0.41, 0.88] | 1 study · 1810 participants | Moderate Downgraded: imprecision |
b) Developmental delay at 18 to 24 months Methylxanthine vs placebo or control | RR 0.88 [0.78, 1] | 1 study · 1725 participants | Moderate Downgraded: imprecision |
Any apneic episodes Methylxanthine vs placebo or control | RR 0.31 [0.18, 0.52] | 4 studies · 167 participants | Moderate Downgraded: imprecision |
Failed apnea reduction Methylxanthine vs placebo or control | RR 0.48 [0.33, 0.7] | 4 studies · 174 participants | Moderate Downgraded: imprecision |
Positive‐pressure ventilation after institution of treatment Methylxanthine vs placebo or control | RR 0.61 [0.39, 0.96] | 9 studies · 373 participants | Low Downgraded: risk of bias, imprecision |
Supplemental oxygen at 36 weeks' postmenstrual age Methylxanthine vs placebo or control | RR 0.77 [0.69, 0.85] | 4 studies · 2142 participants | High |
Methylxanthine compared to placebo or control for the prevention of apnea in preterm infants
Population: preterm infants at risk for apnea
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death or major neurodevelopmental disability at 18 to 24 months Methylxanthine vs placebo or control | RR 1 [0.8, 1.24] | 1 study · 423 participants | Moderate Downgraded: imprecision |
Death at hospital discharge Methylxanthine vs placebo or control | RR 2.19 [0.85, 5.68] | 3 studies · 129 participants | Very low Downgraded: risk of bias, imprecision |
Major neurodevelopmental disability Methylxanthine vs placebo or control | no estimate extracted | NR | No studies |
a) Cerebral palsy or gross motor disability Methylxanthine vs placebo or control | RR 1.03 [0.43, 2.49] | 1 study · 415 participants | Moderate Downgraded: imprecision |
b) Developmental delay Methylxanthine vs placebo or control | RR 1.08 [0.83, 1.4] | 1 study · 396 participants | Moderate Downgraded: imprecision |
Any apneic episodes Methylxanthine vs placebo or control | RR 0.19 [0.09, 0.41] | 2 studies · 104 participants | Low Downgraded: imprecision |
Positive‐pressure ventilation after institution of treatment Methylxanthine vs placebo or control | RR 1.33 [0.48, 3.72] | 4 studies · 208 participants | Low Downgraded: imprecision |
Supplemental oxygen at 36 weeks' postmenstrual age Methylxanthine vs placebo or control | RR 0.78 [0.63, 0.97] | 3 studies · 541 participants | Moderate Downgraded: imprecision |
Methylxanthine compared to placebo or control for the treatment of apnea in preterm infants
Population: preterm infants with apnea
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death or major neurodevelopmental disability at 18 to 24 months Methylxanthine vs placebo or control | RR 0.85 [0.71, 1.01] | 1 study · 767 participants | Moderate Downgraded: imprecision |
Death at hospital discharge Methylxanthine vs placebo or control | RR 0.49 [0.14, 1.78] | 3 studies · 154 participants | Low Downgraded: imprecision |
Major neurodevelopmental disability at 18 to 24 months Methylxanthine vs placebo or control | no estimate extracted | NR | No studies |
a) Cerebral palsy or gross motor disability Methylxanthine vs placebo or control | RR 0.6 [0.29, 1.25] | 1 study · 729 participants | Moderate Downgraded: imprecision |
b) Developmental delay at 18 to 24 months Methylxanthine vs placebo or control | RR 0.86 [0.69, 1.06] | 1 study · 715 participants | Moderate Downgraded: imprecision |
Any apneic episodes Methylxanthine vs placebo or control | RR 0.7 [0.3, 1.62] | 1 study · 43 participants | Very low Downgraded: risk of bias, imprecision |
Failed apnea reduction Methylxanthine vs placebo or control | RR 0.48 [0.33, 0.7] | 4 studies · 174 participants | Low Downgraded: risk of bias, imprecision |
Positive‐pressure ventilation after institution of treatment Methylxanthine vs placebo or control | RR 0.34 [0.12, 0.97] | 5 studies · 192 participants | Low Downgraded: risk of bias, imprecision |
Supplemental oxygen at 36 weeks' postmenstrual age Methylxanthine vs placebo or control | RR 0.72 [0.58, 0.89] | 1 study · 805 participants | Moderate Downgraded: imprecision |
Methylxanthine compared to placebo or control for the prevention of re‐intubation in preterm infants
Population: preterm infants prior to extubation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death or major neurodevelopmental disability at 18 to 24 months Methylxanthine vs placebo or control | RR 0.85 [0.73, 0.99] | 1 study · 676 participants | Moderate Downgraded: imprecision |
Death at hospital discharge Methylxanthine vs placebo or control | no estimate extracted | NR | No studies |
Major neurodevelopmental disability at 18 to 24 months Methylxanthine vs placebo or control | no estimate extracted | NR | No studies |
a) Cerebral palsy or gross motor disability Methylxanthine vs placebo or control | RR 0.54 [0.32, 0.92] | 1 study · 644 participants | Moderate Downgraded: imprecision |
b) Developmental delay at 18 to 24 months Methylxanthine vs placebo or control | RR 0.83 [0.68, 1.01] | 1 study · 612 participants | Moderate Downgraded: imprecision |
Failed extubation Methylxanthine vs placebo or control | RR 0.48 [0.32, 0.71] | 6 studies · 197 participants | Moderate Downgraded: imprecision |
Supplemental oxygen at 36 weeks' postmenstrual age Methylxanthine vs placebo or control | RR 0.81 [0.7, 0.92] | 2 studies · 704 participants | Moderate Downgraded: imprecision |