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Very preterm infants benefited more from caffeine administered early
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Very preterm infants who received early prophylactic caffeine had lower risk for bronchopulmonary dysplasia, patent ductus arteriosus and mortality compared with their peers who received caffeine later, according to data published in JAMA Pediatrics.
Abhay Lodha, MD, MSc, of the University of Calgary, and colleagues assessed caffeine use among 5,101 infants born at less than 31 weeks gestation admitted to 29 neonatal ICUs during the 2010-2012 study. Infants were categorized into two groups: early, if they received caffeine within 2 days after birth; or late, if they received caffeine at least 3 days after birth. Common practice is to administer an initial dose of 10 mg/kg caffeine base followed by a daily maintenance dose of 2.5 to 5 mg/kg caffeine given 24 hours after the initial dose, according to researchers.
Abhay Lodha
Approximately 74.6% of infants (n=3,806) received caffeine early, and 25.4% (n=1,295) received caffeine late. Infants who received early caffeine had higher Apgar scores at 5 minutes and lower SNAP-II scores compared with infants who received late caffeine.
Odds for bronchopulmonary dysplasia and death were lower among infants who received early caffeine (adjusted OR=0.81; 95% CI, 0.67-0.98). This effect may have been due to infants in the early group having reduced rates for bronchopulmonary dysplasia, as there was no difference in mortality between groups, the researchers wrote.
Infants who received late caffeine had a higher incidence of patent ductus arteriosus.
Infants who received late caffeine had longer stays in the neonatal ICU and were more likely to receive mechanical ventilation, high-frequency ventilation and oxygen for a longer duration.
There were no differences in another other outcomes, including severe neurological injury, necrotizing entercolitis, severe retinopathy of prematurity and mortality, between groups.
“Our study found that the very early initiation of caffeine does not appear to be associated with any adverse clinical outcomes,” the investigators wrote. “Early-caffeine therapy is associated with a reduction in the rate of death or bronchopulmonary dysplasia and patent ductus arteriosus in preterm neonates.”
Disclosure: The researchers report no relevant financial disclosures.
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