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Early high-dose caffeine citrate for extremely preterm infants: Neonatal and neurodevelopmental outcomes

Brooke Firman1, Attila Molnar1, Peter H Gray1,2

  • 1Newborn Services, Mater Mothers' Hospital, Brisbane, Queensland, Australia.

Journal of Paediatrics and Child Health
|March 23, 2019
PubMed

Insights

High loading doses of caffeine citrate in preterm infants did not increase the risk of cerebellar haemorrhage or affect neurodevelopmental outcomes. Further research is needed to establish optimal dosing for these vulnerable neonates.

Area of Science:

  • Neonatal Medicine
  • Pharmacology
  • Developmental Pediatrics

Background:

  • Caffeine citrate is commonly used to treat apnea of prematurity in extremely preterm infants.
  • The optimal loading dose of caffeine citrate for maximizing efficacy while minimizing potential morbidities remains under investigation.
  • Neonatal morbidities, such as cerebellar haemorrhage (CBH), and long-term neurodevelopmental outcomes are critical concerns in preterm infant care.

Purpose of the Study:

  • To compare neonatal morbidities, specifically the incidence of cerebellar haemorrhage (CBH), and neurodevelopmental outcomes in extremely preterm infants receiving high versus standard loading doses of caffeine citrate.
  • To evaluate the safety and efficacy of different caffeine citrate loading doses in a preterm infant population.

Main Methods:

  • A retrospective study involving 218 preterm infants (<28 weeks' gestation) who received either a high (median 80 mg/kg) or standard (median 20 mg/kg) loading dose of caffeine citrate within 36 hours of birth.
  • Neonatal morbidities, including CBH, were assessed via cranial ultrasound. Neurodevelopmental outcomes were evaluated at 2 years using the Neuro-Sensory Motor Developmental Assessment (NSMDA) and Bayley Scales of Infant and Toddler Development-III (Bayley-III).

Main Results:

  • No significant difference in the incidence of neonatal morbidities, including CBH, was observed between the high-dose (2.5%) and standard-dose (1.7%) caffeine citrate groups.
  • Neurodevelopmental assessments at 2 years of age showed no significant differences between the infants who received high or standard loading doses of caffeine citrate.
  • The overall incidence of CBH in this study was notably lower than reported in studies utilizing magnetic resonance imaging.

Conclusions:

  • Early administration of high loading doses of caffeine citrate in extremely preterm infants is not associated with an increased risk of CBH or adverse long-term neurodevelopmental outcomes.
  • The findings suggest that current dosing strategies may be safe, but the overall incidence of CBH was lower than anticipated, possibly due to imaging modality differences.
  • A large randomized clinical trial is recommended to definitively determine the optimal early loading dose of caffeine citrate for very preterm infants.
Abstract

Keywords:
caffeinecerebellar haemorrhagecranial ultrasoundneurodevelopmentpreterm infants

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