Caffeine metabolism and excretion in premature infants is limited due to their immature hepatic enzyme, P450 1A2 (CYP1A2), which is involved in caffeine biotransformation to theophylline; and due to immature renal function. Therefore, it is acceptable to say that caffeine elimination is slower in preterm neonates than in full term neonates, due to the fact that preterm neonates have a lower glomerular filtration rate(GFR). The GFR increases rapidly during the first 2 weeks of life and then rises steadily until 8-12 months of age, when adult values are reached. “Caffeine has a longer serum half-life of 101 hours in neonates, whereas its half-life ranges from 3 to 6 hours in adults.” According to a guideline for use of Caffeine Citrate (Cafcit) therapy, reviewed by Dr. Samir Alabsi, “the peak effect of Cafcit is 2 hours; half-life: 40
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Half-life is prolonged in infants with cholestatic hepatitis.” http://www.unitypoint.org/blankchildrens/filesimages/for%20providers/nicu%20medications/caffeine%20citrate%20therapy.pdf Neonates have slow metabolism when first born, but as they age metabolism increases (lexi-drugs). Therefore, it is given once daily and does not need dose adjustment in hepatic and renal failure( lexi-drugs). Acording to Bikash et all., the elimination half-life starts to decrease from birth and reaches the adult values at 60 weeks' post-conception age. Since there is limited data regarding the pharmacokinetics of caffeine administration in neonates with hepatic or renal impairment, caffeine should be administered with caution in this group of patients, so toxic levels are avoided. According to Bikash Shrestha and Gaurav Jawa et all, in preterm neonates, the predominant process of caffeine metabolism is N7 demethylation, which increases exponentially with postnatal age, and is maintained up to 38 weeks until the maturity of the liver.
Half-life is prolonged in infants with cholestatic hepatitis.” http://www.unitypoint.org/blankchildrens/filesimages/for%20providers/nicu%20medications/caffeine%20citrate%20therapy.pdf Neonates have slow metabolism when first born, but as they age metabolism increases (lexi-drugs). Therefore, it is given once daily and does not need dose adjustment in hepatic and renal failure( lexi-drugs). Acording to Bikash et all., the elimination half-life starts to decrease from birth and reaches the adult values at 60 weeks' post-conception age. Since there is limited data regarding the pharmacokinetics of caffeine administration in neonates with hepatic or renal impairment, caffeine should be administered with caution in this group of patients, so toxic levels are avoided. According to Bikash Shrestha and Gaurav Jawa et all, in preterm neonates, the predominant process of caffeine metabolism is N7 demethylation, which increases exponentially with postnatal age, and is maintained up to 38 weeks until the maturity of the liver.