Caffeine citrate for very preterm infants: Effects on development, temperament and behaviour

Area of Science:

• Neonatal Medicine
• Developmental Pediatrics
• Pharmacology

Background:

• Apnea of prematurity is common in neonates born before 30 weeks gestation.
• Caffeine citrate is a standard treatment for apnea of prematurity.
• Optimal dosing strategies for caffeine citrate require further investigation.

Purpose of the Study:

• To compare two caffeine citrate dosing regimens (20 vs. 5 mg/kg/day) in preterm neonates.
• To assess the impact of dosing on neurodevelopment, temperament, and behavior.
• To evaluate safety and efficacy in infants born less than 30 weeks gestation.

Main Methods:

• Multi-center, randomized, controlled trial.
• 287 infants with apnea of prematurity or peri-extubation period randomized.
• Primary outcome: cognitive development at 1 year (Griffiths Mental Development Scales).
• Secondary outcomes: neonatal morbidity, death, disability, temperament, behavior.

Main Results:

• 190 survivors assessed at 1 year corrected age.
• Higher mean general quotient in the high-dose group (98.0 vs. 93.6, P=0.048), though not statistically significant after adjustment.
• Non-significant trend for reduced death or major disability in the high-dose group (15.4% vs. 24.2%).
• No differences in temperament or behavior between groups.

Conclusions:

• A caffeine citrate dosage of 20 mg/kg/day did not lead to adverse developmental, temperamental, or behavioral outcomes.
• The observed trend towards cognitive benefit with higher-dose caffeine warrants further investigation.
• High-dose caffeine citrate appears safe for preterm neonates regarding neurodevelopmental outcomes.