Caffeine for the Treatment of Apnea in Bronchiolitis: A Randomized Trial

Abstract

Clinicaltrials.gov: NCT01435486.

Caffeine for apnea in bronchiolitis

“…In a recent review of apnea in bronchiolitis, 50% of patients were older than 4 months of age. 1 If we had restricted our intervention to infants 8 weeks of age or younger, we would have missed too many infants who might have shown benefit. Every study's sample size limits its power to declare no difference, but it is worth noting that about 75% of our doubleblind placebo recipients had resolution of apnea, further supporting a conclusion of no significant difference.…”

Apnea in Bronchiolitis: Challenges of Studying an Uncommon Complication of a Common Condition

“…Given that apnea in bronchiolitis affects only a small subset of infants with bronchiolitis, a multicenter trial would be required to examine its impact on the need for respiratory support, such as mechanical ventilation. Mechanical ventilation also is an infrequent outcome: a US nationally representative sample of hospitalized infants with bronchiolitis found a rate of mechanical ventilation of 2.3% 10 ; in their study, Alansari et al 7 found a rate of approximately 12%. A composite outcome of noninvasive and invasive ventilation may represent a meaningful outcome that also is feasible to study.…”

“…The trial by Alansari et al 7 does not provide evidence for treatment with caffeine for apnea in bronchiolitis. It is the first trial to examine the use of caffeine in this context and illustrates some of the challenges in conducting pediatric clinical trials.…”

“…In bronchiolitis, case reports, case series, and a retrospective cohort study have described outcomes with the use of caffeine for apnea; authors have called for a trial to determine the efficacy of caffeine in this setting. 5,6 In this volume of The Journal, Alansari et al 7 report on a single-center, randomized controlled trial that evaluated the efficacy and safety of a single dose of intravenous caffeine citrate (25 mg/kg) vs placebo in the treatment of apnea in infants with bronchiolitis. Ninety infants younger than 4 months of age who presented to an emergency department in the State of Qatar with a history of or observed apnea in bronchiolitis were randomized to either treatment arm; randomization was stratified on the basis of gestational age.…”

“…It also will be important, however, for these networks to work together to answer questions, such as the effectiveness of caffeine for apnea in bron-chiolitis, where patient enrollment, interventions, and outcome measurement span the emergency department, inpatient unit, and intensive care unit. The trial by Alensari et al 7 will serve as important foundational work for planning and conduct of a multicenter trial. ■…”