Discontinuing caffeine in preterm infants at 33–35 weeks corrected gestational age: Failure rate and predictive factors

Haddad, Wajed; Sajous, Christine H.; Hummel, Pat; Guo, Rong

doi:10.3233/npm-15814071

Cited by 7 publications

(4 citation statements)

References 16 publications

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“…For example, caffeine therapy, given for apnoea of prematurity, is stopped in infants between 33-35 weeks PMA if the infant appears clinically stable 25 . However, in 10% of infants caffeine treatment is restarted 26 , which may suggest that caffeine was withdrawn too early, exposing the infants to the adverse consequences of lack of treatment. We found that 88% of apnoeas identified using our algorithm were missed in the clinical notes.…”

Section: Discussionmentioning

confidence: 99%

A new method to measure inter-breath intervals in infants for the assessment of apnoea and respiratory dynamics

Purdy

Jorge

Adams

et al. 2021

Preprint

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Background Respiratory disorders, including apnoea, are common in preterm infants due to their immature respiratory control and function compared with term-born infants. However, our inability to accurately measure respiratory rate in hospitalised infants results in unreported episodes of apnoea and an incomplete picture of respiratory dynamics. Methods We develop, validate and use a novel algorithm to identify inter-breath intervals (IBIs) and apnoeas in infants. In 42 infants (a total of 1600 hours of recordings) we assess IBIs from the chest electrical impedance pneumograph using an adaptive amplitude threshold for the detection of individual breaths. The algorithm is refined by comparing its accuracy with clinically-observed breaths and pauses in breathing. We also develop an automated classifier to differentiate periods of true central apnoea from artefactually low amplitude signal. We use this algorithm to explore its ability to identify morphine-induced respiratory depression in 15 infants. Finally, in 22 infants we use the algorithm to investigate whether retinopathy of prematurity (ROP) screening alters the IBI distribution. Findings 88% of the central apnoeas identified using our algorithm were missed in the clinical notes. As expected, morphine caused a shift in the IBI distribution towards longer IBIs, with significant differences in all IBI metrics assessed. Following ROP screening, there was a shift in the IBI distribution with a significant increase in the proportion of pauses in breathing that lasted more than 10 seconds (t-statistic=1.82, p=0.023). This was not reflected by changes in the monitor- derived respiratory rate or episodes of apnoea recorded on clinical charts. Interpretation Better measurement of infant respiratory dynamics is essential to improve care for hospitalised infants. Use of the novel IBI algorithm demonstrates that following ROP screening increased instability in respiratory dynamics can be detected in the absence of clinically-significant apnoeas. Funding Wellcome Trust and Royal Society

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Section: Discussionmentioning

confidence: 99%

A new method to measure inter-breath intervals in infants for the assessment of apnoea and respiratory dynamics

Purdy

Jorge

Adams

et al. 2021

Preprint

View full text Add to dashboard Cite

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“…While the benefits of caffeine therapy are well studied, the appropriate timing of discontinuation relative to infant discharge from the hospital is unknown. Neonatologists typically observe infants for the completion of an "event-free" period after the discontinuation of caffeine therapy as a prerequisite for discharge; [11] however, no consensus among clinicians currently exists in regards to what length of apnea-free period is adequate enough to determine safe discharge [12]. Notably, some infants are discharged home on caffeine as a means of achieving earlier hospital discharge [13,14].…”

Section: Introductionmentioning

confidence: 99%

Wide variation in caffeine discontinuation timing in premature infants

Smith

Clark

et al. 2019

J Perinatol

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Objective To assess site variability and concomitant respiratory support related to the timing of caffeine discontinuation, and compare clinical characteristics of infants who discontinued caffeine before vs. within the last week of hospitalization.Study design Cohort study of 81,110 infants <35 weeks gestational age and <1500 g birth weight discharged from 304 neonatal intensive care units from 2001-2016. ResultsThe mean postmenstrual age at caffeine discontinuation ranged from 32 to 37 weeks among sites. Respiratory support at the time of discontinuation was common, but variable, with 0-57% of infants receiving positive airway pressure at caffeine discontinuation by site. Infants who discontinued caffeine within the last week of hospitalization had longer total duration of caffeine, but were discharged from the hospital at an earlier postmenstrual age. Conclusion There was substantial variability among sites in the timing of caffeine discontinuation before discharge and respiratory support at the time of caffeine discontinuation.

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“…For example, caffeine therapy, given for apnoea of prematurity, is stopped in infants between 33 and 35 weeks PMA if the infant appears clinically stable. 26 However, in 10% of infants, caffeine treatment is restarted, 27 which may suggest that caffeine was withdrawn too early, exposing the infants to the adverse consequences of lack of treatment. We found that 88% of apnoeas identified using our algorithm were not recorded in the medical records, consistent with previous results highlighting the inaccuracies in clinical documentation of apnoea.…”

Section: Discussionmentioning

confidence: 99%

New method to measure interbreath intervals in infants for the assessment of apnoea and respiration

et al. 2021

View full text Add to dashboard Cite

BackgroundRespiratory disorders, including apnoea, are common in preterm infants due to their immature respiratory control compared with term-born infants. However, our inability to accurately measure respiratory rate in hospitalised infants results in unreported episodes of apnoea and an incomplete picture of respiratory activity.MethodsWe develop, validate and use a novel algorithm to identify interbreath intervals (IBIs) and apnoeas in preterm infants. In 42 preterm infants (1600 hours of recordings), we assess IBIs from the chest electrical impedance pneumograph using an adaptive amplitude threshold for the detection of breaths. The algorithm is refined by comparing its accuracy with clinically observed breaths and pauses in breathing. We develop an automated classifier to differentiate periods of true apnoea from artefactually low amplitude signal. We assess the performance of this algorithm in the detection of morphine-induced respiratory depression. Finally, we use the algorithm to investigate whether retinopathy of prematurity (ROP) screening alters the IBI distribution.ResultsIndividual breaths were detected with a false-positive rate of 13% and a false-negative rate of 12%. The classifier identified true apnoeas with an accuracy of 93%. As expected, morphine caused a significant shift in the IBI distribution towards longer IBIs. Following ROP screening, there was a significant increase in pauses in breathing that lasted more than 10 s (t-statistic=1.82, p=0.023). This was not reflected by changes in the monitor-derived respiratory rate and no episodes of apnoea were recorded in the medical records.ConclusionsWe show that our algorithm offers an improved method for the identification of IBIs and apnoeas in preterm infants. Following ROP screening, increased respiratory instability can occur even in the absence of clinically significant apnoeas. Accurate assessment of infant respiratory activity is essential to inform clinical practice.

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Discontinuing caffeine in preterm infants at 33–35 weeks corrected gestational age: Failure rate and predictive factors

Abstract: Caffeine can be discontinued at 33-35 weeks PMA with a failure rate of 10%. BPD and Hispanic ethnicity are predictive of failure. It is generally safe to discharge infants seven days after the caffeine was discontinued if no significant monitor events occur during that time.

Cited by 7 publications

References 16 publications

A new method to measure inter-breath intervals in infants for the assessment of apnoea and respiratory dynamics

A new method to measure inter-breath intervals in infants for the assessment of apnoea and respiratory dynamics

Wide variation in caffeine discontinuation timing in premature infants

New method to measure interbreath intervals in infants for the assessment of apnoea and respiration

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