Impact of Caffeine Boluses and Caffeine Discontinuation on Apnea and Hypoxemia in Preterm Infants

Tabacaru, Christa; Jang, Suk Young; Patel, Maitri; Davalian, Faranek; Zanelli, Santina; Fairchild, Karen D.

doi:10.1089/jcr.2017.0002

Cited by 10 publications

(5 citation statements)

References 35 publications

(41 reference statements)

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“…Overall, we found a modest decrease in number of desaturations and a small decrease in number of bradycardias from 32 to 35 weeks PMA suggesting maturation is occurring allowing infants to “outgrow” these spells. Duration of events decreased to an even smaller extent suggesting that recovery time is slower to mature After discontinuation of CPAP, caffeine, and supplemental oxygen we did not find a significant change in events, in contrast to our prior report of a marginal, transient increase in central apnea with associated bradycardia and desaturation after stopping caffeine (13). A limitation of the analyses is that we could not account for the many clinical variables that might impact heart rate deceleration and oxygen desaturation events with or without central or obstructive apnea during this PMA time frame.…”

Section: Discussioncontrasting

confidence: 99%

“…Episodes of bradycardia and oxygen desaturation, sometimes associated with apnea, are common among preterm very low birth weight (VLBW) infants in the Neonatal Intensive Care Unit (NICU)(1–3). Clinicians administer respiratory support and caffeine to infants early in the NICU course to reduce the frequency and severity of these events, and as infants’ lung disease and control of breathing improve, therapies are weaned and discontinued(4). In some infants, clinically significant bradycardias and desaturations persist as they approach term corrected age and are otherwise ready for discharge home(5), and a more complete understanding of these events might lead to strategies to reduce NICU length of stay (LOS).…”

Section: Introductionmentioning

confidence: 99%

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Recovery from bradycardia and desaturation events at 32 weeks corrected age and NICU length of stay: an indicator of physiologic resilience?

et al. 2019

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Background Preterm very low birth weight (VLBW) infants experience physiologic maturation and transitions off therapies from 32–35 weeks postmenstrual age (PMA), which may impact episodic bradycardia and oxygen desaturation. We sought to characterize bradycardias and desaturations from 32–35 weeks PMA and test whether events at 32 weeks PMA are associated with NICU length of stay. Methods For 265 VLBW infants from 32–35 weeks PMA, we quantified the number and duration of bradycardias (HR <100 for ≥ 4s) and desaturations (SpO2 <80% for ≥ 10s) and compared events around discontinuation of CPAP, caffeine, and supplemental oxygen. We modeled associations between clinical variables, bradycardias and desaturations at 32 weeks PMA, and discharge PMA. Results Desaturations decreased from 60 to 41 per day at 32 and 35 weeks respectively (p<0.01). Duration of desaturations and number and duration of bradycardias decreased to a smaller extent (p<0.05), and there was a non-significant trend toward increased desaturations after stopping CPAP and caffeine. Controlling for clinical variables, longer duration of bradycardias and desaturations at 32 weeks PMA was associated with later discharge PMA. Conclusion Delayed recovery from bradycardias and desaturations at 32 weeks PMA, perhaps reflecting less physiologic resilience, is associated with prolonged NICU stay for VLBW infants.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Recovery from bradycardia and desaturation events at 32 weeks corrected age and NICU length of stay: an indicator of physiologic resilience?

et al. 2019

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“…For example, preterm infants receive caffeine in the first week after birth to minimize central apnea and this might impact HR and SpO 2 patterns. 38 Finally, we chose to focus on the first 7 days after birth in these analyses, but different time windows of HR analysis may be more predictive of eventual diagnosis of CP.…”

Section: Discussionmentioning

confidence: 99%

Heart Rate and Pulse Oximetry Dynamics in the First Week after Birth in Neonatal Intensive Care Unit Patients and the Risk of Cerebral Palsy

et al. 2022

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Objective Infants in the neonatal intensive care unit (NICU) are at high risk of adverse neuromotor outcomes. Atypical patterns of heart rate (HR) and pulse oximetry (SpO2) may serve as biomarkers for risk assessment for cerebral palsy (CP). The purpose of this study was to determine whether atypical HR and SpO2 patterns in NICU patients add to clinical variables predicting later diagnosis of CP. Study Design This was a retrospective study including patients admitted to a level IV NICU from 2009 to 2017 with archived cardiorespiratory data in the first 7 days from birth to follow-up at >2 years of age. The mean, standard deviation (SD), skewness, kurtosis and cross-correlation of HR and SpO2 were calculated. Three predictive models were developed using least absolute shrinkage and selection operator regression (clinical, cardiorespiratory and combined model), and their performance for predicting CP was evaluated. Results Seventy infants with CP and 1,733 controls met inclusion criteria for a 3.8% population prevalence. Area under the receiver operating characteristic curve for CP prediction was 0.7524 for the clinical model, 0.7419 for the vital sign model, and 0.7725 for the combined model. Variables included in the combined model were lower maternal age, outborn delivery, lower 5-minute Apgar's score, lower SD of HR, and more negative skewness of HR. Conclusion In this study including NICU patients of all gestational ages, HR but not SpO2 patterns added to clinical variables to predict the eventual diagnosis of CP. Identification of risk of CP within the first few days of life could result in improved therapy resource allocation and risk stratification in clinical trials of new therapeutics. Key Points

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“…In another retrospective study of 300 preterm infants (GA < 32 weeks), caffeine loading was associated with a significant decrease in ABDs events. 99 While these early studies suggest that variation in RR or apnea/PB events can portend adverse events, the sensitivity and specificity for predicting outcomes appear modest. Moreover, unlike HRCbased algorithms, standardized criteria to delineate normal from abnormal ranges have not been tested in randomized clinical trials.…”

Section: <31 Weeksmentioning

confidence: 99%

Continuous vital sign analysis for predicting and preventing neonatal diseases in the twenty-first century: big data to the forefront

et al. 2019

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In the neonatal intensive care unit (NICU), heart rate, respiratory rate, and oxygen saturation are vital signs (VS) that are continuously monitored in infants, while blood pressure is often monitored continuously immediately after birth, or during critical illness. Although changes in VS can reflect infant physiology or circadian rhythms, persistent deviations in absolute values or complex changes in variability can indicate acute or chronic pathology. Recent studies demonstrate that analysis of continuous VS trends can predict sepsis, necrotizing enterocolitis, brain injury, bronchopulmonary dysplasia, cardiorespiratory decompensation, and mortality. Subtle changes in continuous VS patterns may not be discerned even by experienced clinicians reviewing spot VS data or VS trends captured in the monitor. In contrast, objective analysis of continuous VS data can improve neonatal outcomes by allowing heightened vigilance or preemptive interventions. In this review, we provide an overview of the studies that have used continuous analysis of single or multiple VS, their interactions, and combined VS and clinical analytic tools, to predict or detect neonatal pathophysiology. We make the case that big-data analytics are promising, and with continued improvements, can become a powerful tool to mitigate neonatal diseases in the twenty-first century.

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Impact of Caffeine Boluses and Caffeine Discontinuation on Apnea and Hypoxemia in Preterm Infants

Cited by 10 publications

References 35 publications

Recovery from bradycardia and desaturation events at 32 weeks corrected age and NICU length of stay: an indicator of physiologic resilience?

Recovery from bradycardia and desaturation events at 32 weeks corrected age and NICU length of stay: an indicator of physiologic resilience?

Heart Rate and Pulse Oximetry Dynamics in the First Week after Birth in Neonatal Intensive Care Unit Patients and the Risk of Cerebral Palsy

Continuous vital sign analysis for predicting and preventing neonatal diseases in the twenty-first century: big data to the forefront

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