Timing of Caffeine Therapy and Neonatal Outcomes in Preterm Infants: A Retrospective Study

Abstract

Background. Caffeine is widely used to treat apnea of prematurity. Here, we evaluated the efficacy of early caffeine (1-2 DOL) in decreasing the incidence of adverse neonatal outcomes. Methods. A retrospective cohort was used to compare the neonatal morbidity of 150 preterm neonates with gestational age ≤29 weeks. Infants were divided into 3 groups based on the initiation timing of caffeine therapy; (1) early caffeine (1-2 DOL), (2) late caffeine (3–7 DOL), and (3) very late caffeine (≥8 DOL). Results. The neonatal outcomes of early caffeine were comparable with those of the late caffeine group. Moreover, when comparing the neonatal morbidity of the very late caffeine group with that of the early caffeine group, multivariable logistic regression analyses were performed. We found that the timing of caffeine did not influence the risk of BPD (OR, 0.393; CI, 0.126–1.223; p = 0.107), but birthweight did (OR, 0.996; CI, 0.993–0.999; p = 0.018) in these infants. Conclusion. Neonatal outcomes of preterm infants were comparable whether caffeine was administered early or late in the first 7 DOL. The risk of BPD in infants receiving caffeine after 8 DOL was irrespective of delayed treatment with caffeine. Our results clearly demonstrate the need for further studies before caffeine prophylaxis can be universally recommended.

Antioxidative effects of caffeine in a hyperoxia-based rat model of bronchopulmonary dysplasia

“…In a large clinical trial, caffeine has been shown to reduce the rate of BPD in very preterm infants, shortening the duration time of mechanical ventilation and oxygen supplementation [22]. Caffeine appears to be most effective when started within the first few days of life [23][24][25].…”

A new target for caffeine in the developing lung: endoplasmic reticulum stress?

“…While there is general consensus that early caffeine administration is associated with a reduction in the rates of death or BPD and patent ductus arteriosus (21), some concerns remain regarding possible adverse effects, such as increased risk of necrotizing enterocolitis (34). Some investigators have called for further randomized clinical trials to examine early versus late therapy, before caffeine prophylaxis can be universally recommended for infants under 29 wk of gestational age (16).…”

Early vs Late Caffeine Therapy in Preterm Infants: Analysis of Clinical Outcome

“…This potential benefit of caffeine has been supported by Muhammad et al, Rhein et al and many other authors 17,18 . Similarly CAP trial has clearly demonstrated a reduction in mechanical ventilation by one week by use of caffeine 19 .…”