# Methylxanthine Treatment in Neonates Admitted to the Special Care Unit: An Observational Study in Low-Resource Settings

## TL;DR

This study examines the use of aminophylline in treating apnea of prematurity in neonates in low-resource Sub-Saharan hospitals, finding it was used in about 12% of eligible infants.

## Contribution

The study provides insights into methylxanthine treatment practices in low-resource settings and highlights gaps in protocol adherence for very preterm infants.

## Key findings

- Aminophylline was administered to 11.7% of neonates in two Sub-Saharan hospitals.
- Very preterm infants were less likely to receive aminophylline prophylaxis despite being eligible.
- Aminophylline use was associated with higher rates of respiratory support, IV lines, and mortality.

## Abstract

What are the main findings?
In two Sub-Saharan settings, methylxanthine treatment for apnea of prematurity was limited to aminophylline, which was given to around 12% of infants admitted to the special care units.Overall, the treatment was appropriately given to most eligible neonates, although a considerable subgroup of very preterm infants did not receive aminophylline prophylaxis.

In two Sub-Saharan settings, methylxanthine treatment for apnea of prematurity was limited to aminophylline, which was given to around 12% of infants admitted to the special care units.

Overall, the treatment was appropriately given to most eligible neonates, although a considerable subgroup of very preterm infants did not receive aminophylline prophylaxis.

What is the implication of the main finding?
Further studies may investigate the reasons for protocol incompliance regarding aminophylline treatment and healthcare staff’s opinions on such an aspect.Use of caffeine in these settings may improve adherence to therapeutic protocols.

Further studies may investigate the reasons for protocol incompliance regarding aminophylline treatment and healthcare staff’s opinions on such an aspect.

Use of caffeine in these settings may improve adherence to therapeutic protocols.

Background: The appropriate identification of target patients for methylxanthine therapy may optimize resource allocation and improve clinical outcomes, but data on routine care in low-resource settings are limited. Our study assessed methylxanthine use in clinical practice in two Sub-Saharan settings. Methods: This retrospective, registry-based study investigated methylxanthine use in newborns who were admitted to Tosamaganga Hospital (Tanzania) and Wolisso Hospital (Ethiopia) in 2022–2023. The prevalence and type of methylxanthine treatment were investigated. Neonates receiving methylxanthine were compared to those not receiving it in terms of baseline characteristics, clinical data, treatments, and discharge information. All data were retrieved from local registries. Results: Aminophylline was administered to 196/1674 neonates (11.7%), while caffeine was not available in these settings. This treatment was more common in preterm and smaller infants (p < 0.0001), asphyxiated neonates (p < 0.0001), and the sickest patients (p < 0.001). The need for respiratory support (p < 0.0001), intravenous lines (p < 0.0001), and antibiotic therapy (p < 0.0001), as well as the length of hospital stay (p < 0.0001) and mortality rate (p < 0.0001), were higher in neonates receiving aminophylline. Conclusions: In two Sub-Saharan settings, methylxanthine treatment was limited to aminophylline, which was given to around 12% of infants admitted to the special care units. Overall, the treatment was appropriately given to most eligible neonates, although a considerable subgroup of very preterm infants did not receive aminophylline prophylaxis. Further studies may investigate the reasons for protocol incompliance regarding aminophylline treatment and healthcare staff’s opinions on such an aspect.