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Timing of Caffeine Therapy and Neonatal Outcomes in Preterm Infants: A Retrospective Study
Ivan Hand1, Nahla Zaghloul2, Lily Barash1
1Department of Pediatrics/Division of Neonatology, Kings County Hospital, Brooklyn, NY, USA; Department of Pediatrics, SUNY-Downstate Medical Center, Brooklyn, NY, USA.
Insights
Early caffeine administration (1-2 days of life) for apnea of prematurity showed comparable outcomes to later treatment. Delayed caffeine initiation (after 8 days) did not increase the risk of bronchopulmonary dysplasia in preterm infants.
Area of Science:
- Neonatology
- Pharmacology
Background:
- Caffeine is a standard treatment for apnea of prematurity.
- Early caffeine administration (1-2 days of life) efficacy in reducing adverse neonatal outcomes requires further evaluation.
Purpose of the Study:
- To assess the impact of early caffeine initiation on neonatal morbidity in preterm infants.
- To compare neonatal outcomes based on the timing of caffeine therapy.
Main Methods:
- Retrospective cohort study of 150 preterm neonates (gestational age ≤29 weeks).
- Infants categorized into three groups: early (1-2 DOL), late (3-7 DOL), and very late (≥8 DOL) caffeine administration.
- Multivariable logistic regression analysis used to compare outcomes.
Main Results:
- Neonatal outcomes were similar between early (1-2 DOL) and late (3-7 DOL) caffeine groups.
- Caffeine timing did not significantly influence the risk of bronchopulmonary dysplasia (BPD).
- Birthweight was a significant factor influencing BPD risk (OR, 0.996; CI, 0.993-0.999; p = 0.018).
Conclusions:
- Administering caffeine early (within 7 days of life) or late resulted in comparable neonatal outcomes.
- Delayed caffeine treatment (after 8 DOL) did not correlate with an increased risk of BPD.
- Further research is needed to establish universal recommendations for caffeine prophylaxis.
Abstract:
Background. Caffeine is widely used to treat apnea of prematurity. Here, we evaluated the efficacy of early caffeine (1-2 DOL) in decreasing the incidence of adverse neonatal outcomes. Methods. A retrospective cohort was used to compare the neonatal morbidity of 150 preterm neonates with gestational age ≤29 weeks. Infants were divided into 3 groups based on the initiation timing of caffeine therapy; (1) early caffeine (1-2 DOL), (2) late caffeine (3-7 DOL), and (3) very late caffeine (≥8 DOL). Results. The neonatal outcomes of early caffeine were comparable with those of the late caffeine group. Moreover, when comparing the neonatal morbidity of the very late caffeine group with that of the early caffeine group, multivariable logistic regression analyses were performed. We found that the timing of caffeine did not influence the risk of BPD (OR, 0.393; CI, 0.126-1.223; p = 0.107), but birthweight did (OR, 0.996; CI, 0.993-0.999; p = 0.018) in these infants. Conclusion. Neonatal outcomes of preterm infants were comparable whether caffeine was administered early or late in the first 7 DOL. The risk of BPD in infants receiving caffeine after 8 DOL was irrespective of delayed treatment with caffeine. Our results clearly demonstrate the need for further studies before caffeine prophylaxis can be universally recommended.
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