Bacterial infection in preterm infants during xanthine therapy for idiopathic apnoea of prematurity

Three preterm infants who acquired systemic bacterial infection during xanthine derivative therapy for idiopathic apnoea of prematurity are described. Apnoea, despite therapeutic serum levels of theophylline, was the presenting symptom of infection in two of the infants. Apnoea did not develop in the third infant, despite co‐existent hyponatraemia and intraventricular haemorrhage, though sepsis was diagnosed from other signs. All three infants, including one with Pseudomonas aeruginosa meningitis, responded rapidly to antimicrobial therapy and survived. An increase in the frequency and/or severity of apnoea in a preterm infant being treated with xanthines should alert the physician to symptomatic apnoea such as that associated with bacterial infection. Conversely, the development of symptomatic apnoea may be suppressed by concurrent xanthine derivative therapy for idiopathic apnoea of prematurity.