The Role of Caffeine in Noninvasive Respiratory Support

Dobson, Nicole R.; Patel, Ravi

doi:10.1016/j.clp.2016.07.011

Cited by 22 publications

(19 citation statements)

References 53 publications

(84 reference statements)

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“…C affeine is commonly used to treat apnea of prematurity (AOP), which occurs in nearly all infants <28 weeks gestational age (GA) and many of those <32 weeks GA. [1][2][3] Caffeine has generally been found to be efficacious and safe with a wide therapeutic index, [3][4][5] and some reports suggest that higher doses of caffeine may be more beneficial. 6,7 However there is also some evidence of potential detrimental effects of caffeine, particularly at high doses.…”

Section: Introductionmentioning

confidence: 99%

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

Tabacaru

Jang

Patel

et al. 2017

Journal of Caffeine Research

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Apnea of prematurity often occurs during and following caffeine therapy. We hypothesized that number of apnea events would be impacted by adjustments in caffeine therapy. An automated algorithm was used in all infants ≤32 weeks gestation admitted to a level IV Neonatal Intensive Care Unit from 2009 to 2014 to analyze chest impedance, electrocardiogram, and oxygen saturation data around the time of serum caffeine levels, caffeine boluses while on maintenance therapy, and caffeine discontinuation. Episodes of central apnea/bradycardia/desaturation (ABDs), and percent time with SpO <88% and <75% were measured. ABDs were analyzed in 302 preterm infants (mean gestational age 27.6 weeks) around the time of 485 serum caffeine levels, 90 caffeine boluses, and 273 episodes of caffeine discontinuation. Higher serum caffeine levels were not associated with fewer ABDs or higher heart rate. For caffeine boluses given due to clinically recognized spells, hypoxemia and algorithm-detected ABDs decreased day 1-2 after the bolus compared to the day before and day of the bolus (mean 4.4 events/day after vs. 6.6 before, = 0.004). After caffeine discontinuation, there was no change in hypoxemia and a small increase in ABDs (2 events/day 3-5 days after discontinuation vs. 1 event/day before and >5 days after, < 0.01). This increase in ABDs occurred irrespective of gestational age, respiratory support, or postmenstrual age at the time caffeine was stopped. In this retrospective analysis, caffeine boluses and caffeine discontinuation were associated with a small change in the number of ABD events in preterm infants.

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Section: Introductionmentioning

confidence: 99%

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

Tabacaru

Jang

Patel

et al. 2017

Journal of Caffeine Research

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“…5 Caffeine is widely used to treat or prevent apnea related to prematurity 6 but likely also has beneficial effects on pulmonary compliance and airway resistance, 7,8 minute ventilation, 9 and respiratory muscle contractility 10 that can lead to more effective respiration. Although initiation of caffeine within the first 2 days after birth has been associated with a lower risk of BPD in VLBW infants, 11-14 few studies have evaluated the effect of early caffeine on the risk of initial CPAP failure.…”

mentioning

confidence: 99%

Early Caffeine Prophylaxis and Risk of Failure of Initial Continuous Positive Airway Pressure in Very Low Birth Weight Infants

Patel

Zimmerman

Carlton

et al. 2017

The Journal of Pediatrics

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Objective To test the hypothesis that early caffeine treatment on the day of birth, compared with later treatment in very low birth weight (VLBW, <1500 g) infants receiving continuous positive airway pressure (CPAP) therapy, is associated with a decreased risk of CPAP failure in the first week of life. Study design Multicenter, observational cohort study in 366 US neonatal intensive care units. We evaluated inborn, VLBW infants discharged from 2000 to 2014, who received only CPAP therapy without surfactant treatment on day of life (DOL) 0, had a 5-minute Apgar ≥3, and received caffeine in first week of life. We used multivariable conditional logistic regression to compare the risk of CPAP failure, defined as invasive mechanical ventilation or surfactant therapy on DOL 1-6, by timing of caffeine treatment as either early (initiation on DOL 0) or routine (initiation on DOL 1-6). Results We identified 11 133 infants; 4528 (41%) received early caffeine and 6605 (59%) received routine caffeine. Median gestational age was lower in the early caffeine group, 29 weeks (25th, 75th percentiles; 28, 30) vs the routine caffeine group, 30 weeks (29, 31); P < 0.001. The incidence of CPAP failure on DOL 1-6 was similar between the early and routine caffeine groups: 22% vs 21%; adjusted OR = 1.05 (95% CI: 0.93, 1.18). Conclusions Early caffeine treatment on the day of birth was not associated with a decreased risk of CPAP failure in the first week of life for VLBW infants initially treated with CPAP.

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“…Furthermore, it may be presumed that caffeine was more efficient than aminophylline in maintaining the levels of O 2 saturation, as O 2 desaturation appeared in infants with mixed apnea (28). This effect is apparently associated with the pharmacological action of caffeine in the infants, since the drug has a broader therapeutic index, including increasing the respiratory rate and minute ventilation via stimulating the respiratory center and improving the sensitivity of the central medullary areas to hypercapnia (29,30). Premature infants who experience frequent bouts of apnea may be mechanically ventilated to facilitate their breathing.…”

Section: Discussionmentioning

confidence: 99%

Caffeine versus aminophylline in combination with oxygen therapy for apnea of prematurity: A retrospective cohort study

et al. 2020

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The present study was conducted to investigate the clinical significance of caffeine and aminophylline in the treatment of premature infants with apnea under varying conditions of oxygen (O 2) delivery. The clinical data of 120 premature infants with apnea treated with oxygen therapy and either caffeine citrate (20 mg/kg/day; n=77) or aminophylline (10 mg/kg/day; n=43) were retrospectively examined. The therapeutic performance of the drugs after the completion of the treatment was evaluated primarily according to the risk of recurrent episodes of apnea, the changes in the duration and concentration of inhaled O 2 and the incidence of complications. In contrast to aminophylline, caffeine treatment significantly reduced the duration of O 2 inhalation and the inhaled O 2 concentration in the infants treated with mechanical ventilation or O 2 delivery devices (P<0.05). Treatment with caffeine also decreased the incidence of recurrent apnea events and complications in the investigated population (P<0.05 or P<0.01). Caffeine performs better than aminophylline in the treatment of premature infants with apnea under different conditions of O 2 delivery. The therapeutic performance of caffeine is achieved primarily via improving the efficacy of supplemental O 2 and reducing the incidence of complications.

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The Role of Caffeine in Noninvasive Respiratory Support

Cited by 22 publications

References 53 publications

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

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

Early Caffeine Prophylaxis and Risk of Failure of Initial Continuous Positive Airway Pressure in Very Low Birth Weight Infants

Caffeine versus aminophylline in combination with oxygen therapy for apnea of prematurity: A retrospective cohort study

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