Hesham Abdel‐Hady

Caffeine is the most commonly used medication for treatment of apnea of prematurity. Its effect has been well established in reducing the frequency of apnea, intermittent hypoxemia, and extubation failure in mechanically ventilated preterm infants. Evidence for additional short-term benefits on reducing the incidence of bronchopulmonary dysplasia and patent ductus arteriosus has also been suggested. Controversies exist among various neonatal intensive care units in terms of drug efficacy compared to other methylxanthines, dosage regimen, time of initiation, duration of therapy, drug safety and value of therapeutic drug monitoring. In the current review, we will summarize the available evidence for the best practice in using caffeine therapy in preterm infants.

OBJECTIVE: To evaluate the pregnancy outcome after ovulation induction with aromatase inhibitors or clomiphene citrate (CC). DESIGN: A prospective, randomized, controlled trial. SETTING: A university hospital center and a private practice setting. POPULATION: The study comprised a total of 796 infertile women (1,100 cycles) and 200 spontaneously pregnant women (298 cycles) as a control group. METHODS: Patients were allocated treatment either with 100 mg of CC daily (420 patients, 634 cycles), 5 mg of letrozole daily (269 patients, 323 cycles) or 1 mg of anastrozole daily (107 patients, 143 cycles) for 5 days starting on day 3 of menses. MAIN OUTCOME MEASURES: The occurrence of pregnancy, miscarriage and neonatal condition. RESULTS: Pregnancy occurred in 167/1,398 cycles (11.9%) in total without significant differences between groups. The total miscarriage rate was 16.1% (varied between 14.2% in CC group and 19.9% in anastrozole group) without difference between spontaneous and stimulated pregnancies. There were 129 deliveries in all groups. There were no significant differences between the stimulated and spontaneous pregnancies as regards mean gestational age, premature deliveries, birth weight, SGA<10th percentile or five minutes Apgar score. There was one case of complete cleft palate and one case of major congenital heart problem in the letrozole group. There were two cases of talipus equinovarus in the CC and spontaneous pregnancy group. CONCLUSION: Aromatase inhibitors and CC resulted in favorable pregnancy outcomes and average miscarriage rates. Safety of the drugs for both the mother and fetuses was documented.