High versus standard dose caffeine for apnoea: a systematic review

Vliegenthart, Roos J. S.; Miedema, Martijn; Hutten, Gerard J.; Kaam, Anton H. van; Onland, Wes

doi:10.1136/archdischild-2017-313556

Cited by 42 publications

(54 citation statements)

References 36 publications

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“…The standard dosing regimen of caffeine citrate is loading with 20 mg/kg followed by maintenance of 5–10 mg/kg/day. Higher doses of up to 20 mg/kg/day may be even more effective [131], but this needs further testing in randomised trials as higher doses are also associated with increased risk of cerebellar haemorrhage, hypertonicity and increased seizure burden [132]. …”

Section: Strategiesmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

et al. 2019

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As management of respiratory distress syndrome (RDS) advances, clinicians must continually revise their current practice. We report the fourth update of “European Guidelines for the Management of RDS” by a European panel of experienced neonatologists and an expert perinatal obstetrician based on available literature up to the end of 2018. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, need for appropriate maternal transfer to a perinatal centre and timely use of antenatal steroids. Delivery room management has become more evidence-based, and protocols for lung protection including initiation of CPAP and titration of oxygen should be implemented immediately after birth. Surfactant replacement therapy is a crucial part of management of RDS, and newer protocols for its use recommend early administration and avoidance of mechanical ventilation. Methods of maintaining babies on non-invasive respiratory support have been further developed and may cause less distress and reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation using caffeine and, if necessary, postnatal steroids are also important considerations. Protocols for optimising general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome.

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Section: Strategiesmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

et al. 2019

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“…Meta‐analyses of high‐ versus standard‐dose caffeine showed a significant decrease in the incidence of BPD with high‐dose caffeine, which was not demonstrated in the current study. This may relate to the fact that the high‐dose group was of lower birthweight and required more respiratory intervention, which are risk factors for BPD .…”

Section: Discussionmentioning

confidence: 99%

“…The lack of MRI data, however, limited the quantification of potential microhaemorrhages and their longer‐term neurodevelopmental effect in this study population. We did not find any differences between the high‐ and standard‐dose groups following regression analysis regarding adverse outcomes, and hence, we would agree with Vliegenthart et al that a large RCT (which should be multi‐centric) is needed to determine the optimal dose of caffeine citrate when given early to very preterm infants in order to elucidate whether or not benefits result.…”

Section: Discussionmentioning

confidence: 99%

“…There have been two recent systematic reviews of high‐ versus standard‐dose caffeine. Both have indicated that there was a significant decrease in apnoea of prematurity, bronchopulmonary dysplasia (BPD) and failure to extubate in infants allocated to a higher caffeine dose . In general, adverse effects have been limited to tachycardia but with no clinical indication to withhold caffeine.…”

mentioning

confidence: 99%

“…In the study of Gray et al , the infants received a loading dose of caffeine citrate of 80 mg/kg as a bolus, followed by a maintenance dose of 20 mg/kg/day, while in the study of McPherson et al , the loading dose of caffeine citrate (80 mg/kg) was given in four divided doses at 12‐h intervals, followed by a maintenance dose of 10 mg/kg/day. As many of the studies comparing high‐ and standard‐dose caffeine were of low quality, it was concluded that firm recommendations on the dosage of caffeine could not be given . A survey of neonatologists in Australia and New Zealand, however, found that, while 20 mg/kg of caffeine citrate was the most commonly used loading dose for preterm infants, almost 20% used higher doses …”

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confidence: 99%

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Early high‐dose caffeine citrate for extremely preterm infants: Neonatal and neurodevelopmental outcomes

Firman

Molnár

Gray

2019

J Paediatrics Child Health

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Aim To examine neonatal morbidities, including the incidence of cerebellar haemorrhage (CBH), and neurodevelopmental outcomes following the administration of high loading dose caffeine citrate compared to standard loading dose caffeine citrate. Methods This was a retrospective study of 218 preterm infants <28 weeks’ gestation who received a loading dose of caffeine citrate within the first 36 h of life at the Mater Mothers' Hospital over a 3‐year period (2011–2013). Two groups were compared, with 158 neonates in the high‐dose cohort receiving a median dose of caffeine citrate of 80 mg/kg and 60 neonates in the standard dose cohort receiving a median dose of 20 mg/kg. Routine cranial ultrasound, including mastoid views, was performed during the neonatal period. At 2 years of age, infants presented for follow‐up and were assessed with the Neurosensory Motor Developmental Assessment (NSMDA) and the Bayley Scales of Infant and Toddler Development‐III (Bayley‐III). Results There was no difference in the incidence of neonatal morbidities, including CBH, between the two groups. The incidence of CBH in the high‐dose group was 2.5% compared to 1.7% in the standard‐dose group. There was no difference in the neurodevelopmental follow‐up scores as evaluated with the NSMDA and the Bayley‐III. Conclusions The use of early high loading dose caffeine citrate in extremely preterm infants was not shown to be associated with CBH or abnormal long‐term neurodevelopmental outcomes. The overall incidence of CBH, however, was much lower than in studies using magnetic resonance imaging techniques. It is suggested that a large randomised clinical trial is needed to determine the optimal dose of caffeine citrate when given early to very preterm infants.

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Interventions to Prevent Bronchopulmonary Dysplasia in Preterm Neonates

et al. 2022

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IMPORTANCE Bronchopulmonary dysplasia (BPD) has multifactorial etiology and long-term adverse consequences. An umbrella review enables the evaluation of multiple proposed interventions for the prevention of BPD. OBJECTIVE To summarize and assess the certainty of evidence of interventions proposed to decrease the risk of BPD from published systematic reviews. DATA SOURCES MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, and Web of Science were searched from inception until November 9, 2020. STUDY SELECTION Meta-analyses of randomized clinical trials comparing interventions in preterm neonates that included BPD as an outcome. DATA EXTRACTION AND SYNTHESIS Data extraction was performed in duplicate. Quality of systematic reviews was evaluated using Assessment of Multiple Systematic Reviews version 2, and certainty of evidence was assessed using Grading of Recommendation, Assessment, Development, and Evaluation. MAIN OUTCOMES AND MEASURES (1) BPD or mortality at 36 weeks' postmenstrual age (PMA) and (2) BPD at 36 weeks' PMA.RESULTS A total of 154 systematic reviews evaluating 251 comparisons were included, of which 110 (71.4%) were high-quality systematic reviews. High certainty of evidence from high-quality systematic reviews indicated that delivery room continuous positive airway pressure compared with intubation with or without routine surfactant (relative risk [RR], 0.80 [95% CI, 0.68-0.94]), early selective surfactant compared with delayed selective surfactant (RR, 0.83 [95% CI, 0.75-0.91]), early inhaled corticosteroids (RR, 0.86 [95% CI, 0.75-0.99]), early systemic hydrocortisone (RR, 0.90 [95% CI, 0.82-0.99]), avoiding endotracheal tube placement with delivery room continuous positive airway pressure and use of less invasive surfactant administration (RR, 0.90 [95% CI, 0.82-0.99]), and volume-targeted compared with pressure-limited ventilation (RR, 0.73 [95% CI, 0.59-0.89]) were associated with decreased risk of BPD or mortality at 36 weeks' PMA. Moderate to high certainty of evidence showed that inhaled nitric oxide, lower saturation targets (85%-89%), and vitamin A supplementation are associated with decreased risk of BPD at 36 weeks' PMA but not the competing outcome of BPD or mortality, indicating they may be associated with increased mortality. CONCLUSIONS AND RELEVANCEA multipronged approach of delivery room continuous positive airway pressure, early selective surfactant administration with less invasive surfactant administration, early hydrocortisone prophylaxis in high-risk neonates, inhaled corticosteroids, and volume-targeted ventilation for preterm neonates requiring invasive ventilation may decrease the combined risk of BPD or mortality at 36 weeks' PMA.

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High versus standard dose caffeine for apnoea: a systematic review

Cited by 42 publications

References 36 publications

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

Early high‐dose caffeine citrate for extremely preterm infants: Neonatal and neurodevelopmental outcomes

Interventions to Prevent Bronchopulmonary Dysplasia in Preterm Neonates

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