Prophylactic theophylline for the prevention of severe renal dysfunction in term and post-term neonates with perinatal asphyxia: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: To examine the effect of prophylactic theophylline for the prevention of severe renal dysfunction in post-asphyxiated term and post-term infants. STUDY
DESIGN: Systematic review and meta-analysis of randomized controlled trials (RCTs) comparing prophylactic theophylline vs placebo in term infants following perinatal asphyxia. RESULT: Four RCTs involving 197 infants were included in the meta-analysis. Compared with placebo, prophylactic theophylline was associated with a significant reduction in the incidence of severe renal dysfunction (pooled relative risk) using fixed-effects model was 0.38 (95% confidence interval, 0.25 to 0.57; P<0.001).
CONCLUSION: The meta-analysis provides evidence that prophylactic theophylline significantly reduce the incidence of severe renal dysfunction. However, because of the lack of information on the long-term renal and neurodevelopmental outcome and measured theophylline levels with relation to adverse effects observed, prudence with the clinical use of prophylactic theophylline is required. Additionally, the included trials were prior to the era of therapeutic hypothermia and thus inference of renal benefit in an infant undergoing hypothermia therapy cannot be made.