Two cases are presented illustrating the possible potentiating effect of methylated caffeine in regularizing abnormal breathing patterns in premature newborns, as demonstrated by pneumocardiogram improvements. From these case reports, two main conclusions emerge: (1) Serum methylated caffeine as low as 3-4 µg/ml may regularize abnormal breathing patterns in premature newborns. This response, which can be demonstrated by improvement in their pneumocardiograms, may be a result of the pharmacologic effect of caffeine alone or a result of the additive effect of caffeine to that of theophylline; (2) serum caffeine levels should be measured along with serum theophylline levels in all infants on theophylline therapy. Additionally, because of the premature newborn's remarkably slow elimination of these two methylxanthines, the potentiating effect of methylated caffeine should be considered not only at the initial phase of theophylline therapy, but also during and at the termination of treatment. (Banagale RC. The Influence of Serum Methylated Caffeine Concentration on the Neonatal Pneumocardiogram. Respir Care 1983;28:1569-1573.)
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