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Caffeine for the Treatment of Apnea in Bronchiolitis: A Randomized Trial
Khalid Alansari1, Fatihi Hassan Toaimah2, Hany Khalafalla2
1Division of Pediatric Emergency Medicine, Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar; Division of Pediatric Emergency Medicine, Department of Pediatrics, Sidra Medical and Research Center, Doha, Qatar; Weill Cornell Medical College in Qatar, Doha, Qatar.
Insights
A single dose of caffeine citrate did not effectively reduce apnea in infants with bronchiolitis. This study found no significant difference in apnea-free periods or ventilation needs between caffeine and placebo groups.
Area of Science:
- Pediatric Emergency Medicine
- Neonatology
- Pharmacology
Background:
- Bronchiolitis is a common respiratory infection in infants, often associated with apnea.
- Apnea in infants with bronchiolitis can lead to increased morbidity and healthcare utilization.
- Caffeine citrate is a stimulant that has been explored for managing apnea in neonates.
Purpose of the Study:
- To determine the efficacy of a single intravenous dose of caffeine citrate in treating apnea associated with bronchiolitis in infants.
- To assess the safety of caffeine citrate in this patient population.
Main Methods:
- A randomized, double-blind, placebo-controlled trial was conducted.
- Infants aged ≤4 months with apnea and bronchiolitis received either caffeine citrate (25 mg/kg IV) or saline placebo.
- Primary outcome was a 24-hour apnea-free period; secondary outcomes included apnea frequency and need for ventilation.
Main Results:
- Ninety infants were enrolled; the groups had similar viral positivity rates.
- The mean duration to a 24-hour apnea-free period was comparable between caffeine (28.1 hours) and placebo (29.1 hours) groups (P=.88).
- No significant differences were observed in apnea frequency, need for ventilation, or length of stay; no safety concerns were reported.
Conclusions:
- A single dose of caffeine citrate did not significantly reduce apnea episodes in infants with bronchiolitis.
- The findings suggest that caffeine citrate is not an effective treatment for apnea in this specific clinical context.
- Further research may be warranted to explore alternative or adjunctive therapies.
Objective:
To evaluate the efficacy and safety of caffeine citrate in the treatment of apnea in bronchiolitis.
Study Design:
Eligible infants aged ≤4 months presenting to the main pediatric emergency service with apnea associated bronchiolitis were stratified by gestational age (<34 weeks or longer) and randomized to receive a single dose of intravenous 25 mg/kg caffeine citrate or saline placebo. The primary efficacy outcome was a 24-hour apnea-free period beginning after completion of the blinded study drug infusion. Secondary outcomes were frequency of apnea by 24, 48, and 72 hours after study medication, need for noninvasive/invasive ventilation, and length of stay in the hospital's pediatric intensive care/step-down unit.
Results:
A total of 90 infants diagnosed with viral bronchiolitis associated with apnea (median age, 38 days) were enrolled. The rate of respiratory virus panel positivity was similar in the 2 groups (78% for the placebo group vs 84% for the caffeine group). The geometric mean duration to a 24-hour apnea-free period was 28.1 hours (95% CI, 25.6-32.3 hours) for the caffeine group and 29.1 hours (95% CI, 25.7-32.9 hours) for the placebo group (P = .88; OR, 0.99; 95% CI, 0.83-1.17). The frequency of apnea at 24 hours, 24-48 hours, and 48-72 hours after enrollment and the need for noninvasive and invasive ventilation were similar in the 2 groups. No safety issues were reported.
Conclusions:
A single dose of caffeine citrate did not significantly reduce apnea episodes associated with bronchiolitis.
Trial Registration:
Clinicaltrials.gov: NCT01435486.
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