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The effect of caffeine citrate on neural breathing pattern in preterm infants
Vilhelmiina Parikka1, Jennifer Beck2, Qian Zhai3
1Department of Pediatrics, Turku University Hospital, University of Turku, Turku, Finland.
Insights
Caffeine citrate effectively reduces central apnea in premature infants by stimulating neural breathing. This treatment increases diaphragm electrical activity, enhancing energy expenditure and improving respiratory control.
Area of Science:
- Neonatal Physiology
- Respiratory Control
- Pharmacology
Background:
- Caffeine citrate is a standard treatment for apnea of prematurity.
- Understanding its precise effects on neural breathing control is crucial for optimizing its use.
Purpose of the Study:
- To investigate the impact of caffeine citrate on the neural control of breathing in preterm infants.
- To specifically characterize its effects on central apnea and diaphragm electrical activity (Edi).
Main Methods:
- Seventeen preterm infants (mean age 3 days, birth weight 900g) were studied.
- Diaphragm electrical activity (Edi) was measured using miniaturized sensors before and after caffeine citrate loading (20mg/kg).
- Central apnea was defined as >5s of flat Edi; neural inspiratory time, respiratory rate, peak Edi, and phasic Edi were analyzed.
Main Results:
- Caffeine citrate significantly reduced the number of short (5-10s) central apneas (from 12±11 to 7±7; p=0.02).
- The treatment led to a significant increase in both peak and phasic Edi.
- This increase in Edi signifies heightened diaphragm energy expenditure.
Conclusions:
- The Edi signal provides a reliable method for studying neural breathing changes in preterm infants.
- Caffeine citrate's efficacy in reducing apnea is linked to stimulated neural breathing and increased diaphragm energy expenditure.
Background:
Caffeine citrate is widely used to prevent and treat prematurity-associated apnea.
Aims:
The aim of this study was to characterize the effect of caffeine citrate on the neural control of breathing, especially central apnea, in premature infants.
Study Design:
Preterm infants were evaluated for 30min before and 30min after caffeine citrate loading (20mg/kg). A feeding tube including miniaturized sensors was used to measure the diaphragm electrical activity (Edi) waveform. Central apnea was defined as any period where the Edi waveform was flat for >5s.
Subjects:
Seventeen preterm infants with a mean age of three days and mean birth weight of 900 grams were evaluated.
Outcome Measures:
In addition to central apnea, several parameters including neural inspiratory time, neural respiratory rate, peak Edi, delta inspiratory change in Edi (phasic Edi) and minimum Edi on exhalation were measured.
Results:
The majority of the apnea were short (5 to 10s) and the number of apnea correlated with birth weight (p=0.039). Caffeine citrate reduced significantly the number of 5-to-10-second-long central apnea during the 30-minute periods (12±11 to 7±7; p=0.02). Caffeine citrate increased both peak and phasic Edi leading to a significant increase in the diaphragm energy expenditure.
Conclusions:
Edi signal can be reliably measured and processed to study changes in premature infants' neural breathing. The beneficial effect of caffeine citrate on the reduction of the number of apnea is mediated through stimulated neural breathing increasing the diaphragm energy expenditure.
