Caffeine is widely regarded as the drug of choice for apnea of prematurity.1,2 This is largely based on its efficacy and relatively wide therapeutic index.1,2 A recent article by Natarajan et al. concluded that monitoring caffeine serum concentrations is not necessary when caffeine is used for apnea of prematurity.3 The premise for their conclusions is based on results from a retrospective review of 101 neonates who received 5 to 8 mg/kg/day caffeine for apnea of prematurity. The authors concluded that because 94% of measured serum caffeine concentrations were within the “therapeutic range” (5.1 to 20 mg/L [2.5 to 10 mmol/L]) there was no need to routinely monitor serum concentrations.

Is it sufficient to know that caffeine serum concentrations are in the “therapeutic range” when a patient is experiencing an increase in apnea events, or when concentrations...

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