A randomised, double blind, placebo controlled triad of the effect of theophylline in prevention of vasomotor nephropathy in very preterm neonates with respiratory distress syndrome

Background: Vasomotor nephropathy is a common renal dysfunction in very preterm neonates. Objective: To determine whether theophylline could prevent vasomotor nephropathy in very preterm infants with respiratory distress syndrome. Methods: A randomised, double blind, placebo controlled trial of 50 preterm infants of gestational age <= 32 weeks needing assisted ventilation. Infants received an intravenous dose of theophylline (1 mg/kg) or placebo for three days. The 24 hour urine volume was measured daily. On days 2, 5, and 11, blood samples and 12 hour urine collections were analysed for electrolytes, creatinine, and urea. Results: On day 1, urine output was significantly higher in the theophylline (2.4 (0.9) ml/kg/h) than the placebo (1.6 (1.0) ml/kg/h; p = 0.023) group (values are mean (SD)). The incidence of oligoanuria was significantly lower in the theophylline treated (5%) than the placebo (33%) group. Twenty four hours after the first administration of theophylline/placebo, serum creatinine concentration was significantly lower in the theophylline (0.76 (0.23) mg/dl) than the placebo (1.0 (0.41) mg/dl; p = 0.025) group. On day 5 an increase in serum creatinine was observed in both groups. On day 11 a significant reduction in serum creatinine was observed, compared with day 5, with no difference between the two groups. Conclusion: The results suggest that, in very preterm infants with respiratory distress syndrome, early theophylline administration improves renal function during the first two days of life.