The CAP trial remains the standard, which showed an improvement in medium term, and very long term, outcomes after caffeine use among infants of less than 1250 g birth weight, less than 10 days of age started on caffeine (or placebo) because the attending physician thought they needed caffeine. There were some pharmacokinetic studies, but few quality pharmacodynamic studies, those that existed rarely used objective quantification of apnoea frequency, which is essential to be able to say much about the impacts on apnoea, nursing records of apnoea spells being notoriously unreliable. The maintenance dose gradually stabilised over the years, although there have been repeated questions about whether it is the optimal dose. J Pediatr 1977 90(3):467-72), they used 20 mg/kg of caffeine citrate as a load, and 5 to 10 mg/kg/dose once or twice a day, starting 48 to 72 hours after the load. Efficacy of caffeine in treatment of apnea in the low-birth-weight infant. It seemed to be a safe dose, that did not require serum concentration surveillance, but was not based on a large number of high quality dose ranging trials, indeed it was identical to the doses used in the very first publication of caffeine use in the preterm infant, published in 1977 by Jack Aranda, from Montreal (the McGill side of the mountain). The dose of caffeine that we used for the CAP trial was the dose that was being widely used at the time.
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