Variations in preterm stabilisation practices and caffeine therapy between two European tertiary level neonatal units

Abstract

Aim To investigate interinstitutional differences in preterm infant stabilisation between two European tertiary neonatal centres with particular focus on intubation timing, surfactant administration, caffeine therapy and neonatal morbidity and mortality. Methods Retrospective (2012‐2014) study of very low birth weight (VLBW) preterm infants admitted to John Radcliffe Hospital (UK centre) and Charité Medical Centre (German centre). Timing of intubation, surfactant and caffeine administration and respiratory outcomes were examined. Results Gestational age, birth weight and five‐minute Apgar scores of VLBW infants from the UK centre (n = 86) were comparable to those from the German centre (n = 96). Significant differences in antenatal steroid therapy, intubation timing and surfactant therapy were noted. Timing of caffeine initiation differed significantly between centres (median 0 [0‐2.5] UK vs. 2 [1.5‐4] days German centre); however, caffeine was discontinued at a similar corrected gestational age of 34.7 weeks. Mechanical ventilation was significantly longer at the UK centre, but there was no difference in bronchopulmonary dysplasia (BPD) (44% UK vs. 36% German centre) or mortality (15% UK vs. 13% German centre). Conclusion Timing of primary intubation and caffeine therapy differed significantly between centres. However, earlier intubation and caffeine administration in the UK centre were not associated with a changed incidence of BPD.

Is earlier better when it comes giving caffeine to preterm infants or are we risking unnecessary treatment and serious harm?

“…Caffeine was discontinued at the same corrected gestational age of 34.7 weeks, in line with other studies such as the Caffeine for Apnoea of Prematurity trial . However, there was an important difference in the timing of caffeine initiation, with medians and interquartile ranges of zero days (0‐2.5) in the UK and 2 days (1.5‐4) in Germany ( P < .001) . The authors state that the earlier use of caffeine in the UK was not associated with reduced rates of bronchopulmonary dysplasia.…”

“…7 However, there was an important difference in the timing of caffeine initiation, with medians and interquartile ranges of zero days (0-2.5) in the UK and 2 days (1.5-4) in Germany (P < .001). 6 The authors state that the earlier use of caffeine in the UK was not associated with reduced rates of bronchopulmonary dysplasia. However, due to substantial differences in baseline characteristics between the two neonatal units, we doubt that it was possible to interpret these data and draw conclusions with confidence.…”

“…In this issue of Acta Paediatrica, Belkhatir et al 6 report the results of a two-centre retrospective cohort study on stabilisation practices and caffeine therapy in very low birthweight infants. Their aim was to assess initial preterm stabilisation practices, with a particular focus on the timing of caffeine therapy and respiratory outcomes, in two tertiary neonatal units: the John Radcliffe Hospital, Oxford, UK, and the Charité University Medical Centre, Campus Mitte, Berlin, Germany.…”

Pulmonary hypertension in bronchopulmonary dysplasia

“…These preventive measures include, but are not limited to: less use of invasive mechanical ventilation and predominant use of non-invasive respiratory support strategies, minimally invasive surfactant application, avoidance of hyper-and hypoxia, caffeine, corticosteroids, and reduction of infections. [63][64][65][66] Further research is required to determine the role of caffeine and corticosteroids on the developing pulmonary vasculature. The same is true for a possible contribution of a hemodynamically significant PDA (here: sole left-to-right shut) to PH and PVD in BPD infants.…”

Prevention of Oxygen-Induced Inflammatory Lung Injury by Caffeine in Neonatal Rats

“…Data from initial clinical studies of caffeine therapy show a reduction in BPD rates [19,20] and significant improvement of lung function [21]. The discussed early prophylactic caffeine treatment before extubation is partly associated with a reduced incidence of BPD [22][23][24] but also linked with a higher mortality compared to a later start of caffeine administration (>3 postnatal days) [25,26].…”