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Caffeine is effective in reducing the number of episodes of neonatal apnea. Apnea is most frequently seen in premature infants and is a significant contributor to the morbidity of low birth weight infants. Because of its long half-life, daily administration is common. Monitoring of caffeine levels is usually performed only on those patients who are unresponsive to high doses of caffeine or who have signs of toxicity. The neonate does not have a well-developed cytochrome P450 system for metabolism of caffeine so toxicity is a concern. Signs of toxicity include tachycardia, gastrointestinal intolerance, and jitteriness. Toxicity is usually not observed at caffeine concentrations below 80 ug/mL. Sever life threatening toxicity has been reported at concentrations above 300 mg/l.
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