Clinical Question: Does creatine supplementation improve symptoms of apnea of prematurity?

Setting: Inpatient (intensive care unit only)

Study Design: Randomized controlled trial (double-blinded)

Synopsis: Creatine is used in cells to produce energy and has been shown to diminish muscle fatigue in animals and adult humans. Researchers tested the role of creatine in improving the symptoms of apnea of prematurity in 38 preterm infants with a gestational age younger than 32 weeks and symptoms of apnea of prematurity severe enough to require treatment.

The infants were randomized (allocation concealment unknown) to receive creatine monohydrate in a dosage of 200 mg per kg per day or placebo for two weeks in eight to 12 doses per day. Therapy began after the onset of apnea of prematurity, a median of nine days after birth. Breathing movements, nasal airflow, pulse rate, and oxygen saturation by pulse oximeter were measured before treatment and after seven and 14 days of treatment.

In the 34 children who completed the study, no effect was seen on bradycardia or desaturation episodes per hour, isolated apnea episodes per hour, or any other measured outcome at seven or 14 days. The study had the power to detect one standard-deviation-point improvement in the combined rate of bradycardia and desaturation episodes per hour.

Bottom Line: Creatine supplementation (20 mg per kg per day) is not effective in treating the symptoms of apnea of prematurity. For this study, supplementation began after the onset of symptoms; earlier treatment (i.e., from birth) may result in symptom improvement, but that theory has not been verified. (Level of Evidence: 1c)