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Acute hemodynamic effects of caffeine administration in premature infants
V Soloveychik1, A Bin-Nun, A Ionchev
1Neonatology Section, Department of Pediatrics, Comer's Children Hospital, The University of Chicago, Chicago, IL, USA. vsoloveychik@yahoo.com
Insights
Caffeine citrate administration in premature infants with apnea of prematurity consistently increases cardiac output and blood pressure. This suggests a potential role for caffeine in managing hypotensive or hypoperfused infants.
Area of Science:
- Neonatal Physiology
- Pharmacology
- Cardiovascular Medicine
Background:
- Caffeine citrate is a standard treatment for apnea of prematurity.
- Caffeine's known pharmacologic effects suggest potential hemodynamic impacts.
Purpose of the Study:
- To investigate the hemodynamic effects of intravenous caffeine administration in premature infants.
- To assess changes in heart rate, stroke volume, cardiac output, and vascular resistance.
Main Methods:
- Prospective observational study in 31 premature infants receiving intravenous caffeine.
- Echocardiography used to measure stroke volume via velocity time integral and aortic root diameter.
- Statistical analyses included paired t-tests, sign tests, and multivariate linear regression.
Main Results:
- Intravenous caffeine significantly increased cardiac index (14.6%), stroke volume (7.8%), heart rate (7.7 bpm), and blood pressure (4.1 mm Hg) in all infants.
- No significant effect of caffeine dose, birth weight, gestational age, or postnatal age was found on these hemodynamic parameters.
Conclusions:
- Intravenous caffeine administration reliably enhances cardiac output and blood pressure in premature infants treated for apnea.
- Caffeine may be beneficial in the hemodynamic management of hypotensive or hypoperfused premature infants.
Objective:
Administration of caffeine citrate (caffeine) has been a central component of the treatment of apnea of prematurity. However, given its multiple pharmacologic effects, caffeine might be expected to produce hemodynamic changes in heart rate, stroke volume, cardiac output and vascular resistance.
Study Design:
In this prospective observational study, we report the hemodynamic effects of intravenous caffeine administration in a population of premature infants who received caffeine to correct or prevent apnea of prematurity.
Methods:
Hemodynamic effects of caffeine were determined in 31 infants. Stroke volume was measured via echocardiogram, using velocity time integral at the aortic root diameter. Statistically univariate analyses were performed parametrically using paired t-test and nonparametrically (sign test). Multivariate linear regression models were used to identify subgroup covariate effects.
Results:
After intravenous caffeine, cardiac index increased in 31 of 31 trials, by an average of 14.6+/-16.3% (s.d.); stroke volume increased in 24 of 31 trials, by 7.8+/-12.2%; heart rate increased in 28 of 31 trials by 7.7+/-7.2 beats per min; and blood pressure increased in 25 of 31 trials, by 4.1+/-5.8 mm Hg (all P<0.001). Multivariate linear regression revealed no significant effect of dose, birth weight, gestational age or postnatal age.
Conclusions:
Intravenous caffeine consistently increases cardiac output and blood pressure in relatively stable premature infants, when given to treat or prevent apnea of prematurity. We speculate that there may be a role for caffeine in the hemodynamic treatment of hypotensive/hypoperfused infants.
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