Is Early Preventive Caffeine Safe and Effective in Premature Neonates? A Clinical Trial (original) (raw)
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High versus low-dose caffeine for apnea of prematurity: a randomized controlled trial
European Journal of Pediatrics, 2015
The optimum caffeine dose in preterm infants has not been well investigated. We aimed to compare the efficacy and safety of high versus low-dose caffeine citrate on apnea of prematurity (AOP) and successful extubation of preterm infants from mechanical ventilation. We compared high-dose (loading 40 mg/kg/day and maintenance of 20 mg/kg/day) versus low-dose (loading 20 mg/kg/day and maintenance of 10 mg/kg/day) caffeine citrate in preterm infants <32 weeks gestation, presented with AOP within the first 10 days of life. A total of 120 neonates (60 in each group) were enrolled. High-dose caffeine was associated with a significant reduction in extubation failure in mechanically ventilated preterm infants (p<0.05), the frequency of apnea (p<0.001), and days of documented apnea (p<0.001). High-dose caffeine was associated with significant increase in episodes of tachycardia (p<0.05) without a significant impact on physician decision to withhold caffeine.
Early versus Late Caffeine: Meta Analysis, 2023
Background: Caffeine is commonly used as therapy for apnea of prematurity and has shown potential in preventing other conditions in preterm neonates. However, the optimal timing for caffeine therapy remains uncertain. Objective: This study aimed to compare the outcomes of early versus late administration of caffeine in preterm neonates. Methods: PubMed, Embase, and Cochrane Library were searched for studies comparing 0-2 days to ≥3 days caffeine introduction in preterm neonates. Outcomes included were mortality, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), patent ductus arteriosus (PDA), late-onset sepsis, length of hospital stay, and the composite of BPD or death. RevMan 5.4.1 was used for statistical analysis. Results: A total of 122,579 patients from 11 studies were included, 2 were randomized controlled trials (RCTs), and 63.9% of the neonates received early caffeine administration. The rates of BPD (OR: 0.
A Study on Outcome of Early Caffeine Administration in Very Preterm Neonates
Asian Journal of Clinical Pediatrics and Neonatology, 2019
Background: Apnea intervals frequently occur in very preterm infants. Methylxanthenes stimulate breathing efforts and hence have been used for treating apnea of prematurity. Aim: to study the outcome of early caffeine administration in very preterm neonates. Subjects and Methods: The first (1st) group babies received early caffeine within 48 hours of life before developing apnea. The second group (2nd) group babies received caffeine late after 48 hours, after onset of apneic episode. Results: There was no significant difference in the number of episodes of apnea, bradycardia and hypoxemia. Also no significant difference in the incidence of Patent ductus arteriosus (PDA), Intra ventricular hemorrhage (IVH), Necrotizing enterocolitis (NEC), Retinopathy of prematurity (ROP) or Bronchopulmonary dysplsia (BPD). Conclusion: There was no significant difference noted in the number of episodes of apnea, bradycardia and hypoxemia in the group with early caffeine administratration compared to late caffeine administration.
Early caffeine therapy for prevention of bronchopulmonary dysplasia in preterm infants
Objective: To determine if an early commencement of caffeine is associated with improved survival without bronchopulmonary dysplasia (BPD) in preterm infants. Methods: Retrospective data analysis from the Alere Neonatal Database for infants weighing 1250 g, and treated with caffeine within the first 10 days of life. The neonatal outcomes were compared between the infants who received early caffeine (0–2 days) with the infants who received delayed caffeine (3–10 days). Results: A total of 2951 infants met the inclusion criteria (early caffeine 1986, late caffeine 965). The early use of caffeine was associated with reduction in BPD (OR 0.69, 95% CI 0.58–0.82, p50.001) and BPD or death (OR 0.77, 95% CI 0.63–0.94, p ¼ 0.01). Other respiratory outcomes also improved with the early commencement of caffeine. The frequency of severe intraventricular hemorrhage and patent ductus arteriosus was lower and the length of hospitalization was shorter in infants receiving early caffeine therapy. However, early use of caffeine was associated with an increase in the risk of nectrotizing enterocolits (NEC) (OR 1.41, 95% CI 1.04–1.91, p ¼ 0.027). Conclusion: Early commencement of caffeine was associated with improvement in survival without BPD in preterm infants. The risk of NEC with early caffeine use requires further investigation.
Early caffeine therapy and clinical outcomes in extremely preterm infants
Journal of Perinatology, 2013
To determine if early caffeine therapy is associated with decreased bronchopulmonary dysplasia (BPD) or death, decreased treatment of patent ductus arteriosus (PDA), or shortened duration of ventilation. Study Design: In a retrospective cohort of 140 neonates ≤ 1250 grams at birth, infants receiving early caffeine (EC, initiation < 3 days of life) were compared to those receiving late caffeine (LC, initiation ≥ 3 days of life) using logistic regression. Result: Of infants receiving EC, 25% (21/83) died or developed BPD compared to 53% (30/57) of infants receiving LC (adjusted odds ratio (aOR) 0.26, 95%CI 0.09-0.70; p<0.01). PDA required treatment in 10% of EC infants versus 36% of LC infants (aOR 0.28, 95%CI 0.10-0.73; p=0.01). Duration of mechanical ventilation was shorter in infants receiving EC (EC, 6 days; LC, 22 days; p<0.01). Conclusion: Infants receiving early caffeine therapy had improved neonatal outcomes. Further studies are needed to determine if caffeine prophylaxis should be recommended for preterm infants.
Caspian journal of internal medicine, 2018
Caffeine is widely used for prevention of apnea and helps successful extubation from mechanical ventilation. It facilitates the transition from invasive to noninvasive support and reduces duration of continuous positive airway pressure (CPAP) in preterm infants. The optimum caffeine dose in preterm infants has not been well-studied in terms of benefits and risks. We compared efficacy and safety of once versus twice-daily caffeine dose in premature infants. This study was a randomized clinical trial conducted in Bu-Ali Sina Teaching Hospital, Sari. Patients with gestational age of <37 weeks were included. Both groups received 20 mg/kg loading dose of caffeine intravenously followed by maintenance dose of 5 mg/kg/day in group 1 or 2.5 mg/kg every 12 hours in group 2. Extubation failure, CPAP failure and possibly adverse reactions were evaluated. The mean of gestational age and birth weight were 32.27±3.23 (weeks) and 1824.5±702.54 (gr), respectively. The rate of extubation and CPAP...
Frontiers in Pediatrics
IntroductionCaffeine is one of the most used drugs in the neonatal intensive care units (NICUs). It is widely regarded as beneficial in preventing many morbidities by reducing apnea of prematurity and improving respiratory functions.MethodsPremature infants with gestational ages >25 and <32 weeks who were hospitalized in the NICU between 2008 and 2013 and survived up to discharge were retrospectively analyzed. Infants treated with prophylactic caffeine were compared with historical controls born in 2008 and did not receive caffeine treatment. Maternal and neonatal characteristics and common neonatal morbidities were recorded.ResultsA total of 475 patients were analyzed. The patients receiving caffeine were classified as Group 1 (n = 355), and the patients not receiving caffeine were classified as Group 2 (n = 120). Despite the higher incidence of respiratory distress syndrome requiring surfactant therapy and a longer duration of respiratory support in Group 2, the rates of bro...
Caffeine Administration to Prevent Apnea in Very Premature Infants
Pediatrics & Neonatology, 2016
Background: Apnea intervals frequently occur in premature infants. Periods of apnea occur more often with decreases in gestational age. Periods of apnea can cause damage to the infant's developing brain and other organs. This study was designed to investigate the preventive effects of caffeine on apnea incidence in higher-risk neonates. Methods: In this single-center randomized control trial study, premature infants with a birth weight of 1200 g were eligible for enrollment. Twenty-six infants were randomly assigned to receive 20 mg/kg caffeine, as the loading dose, which was followed by 5 mg/kg daily as the maintenance dose until the 10 th day of life; these infants were compared with 26 infants in the control group. Primary outcomes were incidence of apnea, bradycardia, and cyanosis. Results: Fifty-two infants were enrolled (26 in the caffeine group and 26 in the control group). The preventive effect of caffeine on apnea was significant in these infants. The relative risk for incidence of apnea in preterm neonates with a birth weight of <1200 g was 0.250 (95% confidence interval, 0.097e0.647). Only four infants (15.4%) in the caffeine group developed apnea, compared with 16 (61.5%) in the control group (p Z 0.001). Conclusion: It seems that preventative effects of caffeine on apnea become apparent by using the drug in very premature infants.
Serum caffeine concentrations and short-term outcomes in premature infants of ⩽29 weeks of gestation
Journal of perinatology : official journal of the California Perinatal Association, 2014
Objective:Caffeine is effective in the treatment of apnea of prematurity but it is not well known if the therapeutic concentration of the drug has an impact on other neonatal outcomes such as chronic lung disease (CLD). The aim of this study was to determine if there is an association between caffeine concentrations and the incidence of CLD in premature infants of ⩽29 weeks of gestation.Study design:A retrospective chart review of all the infants born ⩽29 weeks of gestation from 2007 to 2011, who survived until discharge or 36 weeks postmenstrual age, was conducted. Caffeine concentrations were obtained weekly on infants getting the drug. Average caffeine concentrations (ACCs) were determined for the duration of caffeine therapy and correlated with CLD, length of stay (LOS), oxygen at discharge (OD), duration of ventilation (DV) and total charges for hospitalization for each patient.Results:Of the 222 eligible infants, 198 met the inclusion criteria. ACC for infants without CLD was ...