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Wide variation in caffeine discontinuation timing in premature infants

Dabin Ji1, P Brian Smith2,3, Reese H Clark4

  • 1Mercer University School of Medicine, Savannah, GA, USA.

Journal of Perinatology : Official Journal of the California Perinatal Association
|November 24, 2019
PubMed

Insights

Site variability exists in caffeine discontinuation timing and respiratory support for premature infants. Discontinuing caffeine later in hospitalization led to longer caffeine use but earlier discharge.

Area of Science:

  • Neonatal Medicine
  • Pediatric Pharmacology
  • Clinical Neonatology

Background:

  • Caffeine citrate is widely used to treat apnea of prematurity.
  • Optimal timing for caffeine discontinuation is not well-established.
  • Variability in clinical practice exists regarding caffeine cessation in neonatal intensive care units.

Purpose of the Study:

  • To evaluate site-specific variations in the timing of caffeine discontinuation.
  • To assess the use of respiratory support at the time of caffeine cessation.
  • To compare infant characteristics based on caffeine discontinuation timing relative to hospital discharge.

Main Methods:

  • Retrospective cohort study.
  • Inclusion of 81,110 infants born before 35 weeks gestational age and weighing less than 1500g.
  • Data collected from 304 neonatal intensive care units between 2001 and 2016.

Main Results:

  • Mean postmenstrual age at caffeine discontinuation varied from 32 to 37 weeks across sites.
  • Respiratory support at caffeine discontinuation ranged from 0% to 57% by site.
  • Infants discontinuing caffeine within the last week of hospitalization had longer caffeine duration but earlier discharge postmenstrual age.

Conclusions:

  • Significant variability exists among neonatal intensive care units regarding the timing of caffeine discontinuation.
  • Substantial differences in respiratory support at caffeine cessation were observed between sites.
  • Further research is needed to standardize caffeine discontinuation protocols.
Abstract

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