Caffeine in preterm infants: where are we in 2020?

Area of Science:

• Neonatology
• Pharmacology
• Respiratory Medicine

Background:

• Increasing preterm birth rates lead to infants with potential long-term pulmonary issues.
• Apnea of prematurity (AOP) is a significant challenge, often requiring mechanical ventilation with associated risks like bronchopulmonary dysplasia (BPD).
• Non-invasive respiratory support is preferred, with pharmacological treatment of AOP as a key strategy.

Purpose of the Study:

• To review current knowledge on caffeine citrate therapy for AOP in preterm infants.
• To highlight unresolved questions regarding optimal dosing, timing, and therapeutic drug monitoring.
• To discuss the potential for improved respiratory management and patient outcomes with a better understanding of caffeine.

Main Methods:

• This is a state-of-the-art review.
• It summarizes existing literature on caffeine citrate's efficacy and safety in preterm infants.
• It identifies gaps in current clinical practice and research.

Main Results:

• Caffeine citrate is the preferred pharmacological treatment for AOP, reducing mechanical ventilation needs and BPD risk.
• It is associated with improved cognitive and pulmonary function outcomes in preterm infants.
• Current dosing regimens are generally safe and effective, but standardized protocols are lacking.

Conclusions:

• Caffeine citrate therapy is crucial for managing AOP and improving outcomes in preterm infants.
• Further research is needed to establish standardized protocols for dosing and therapeutic drug monitoring.
• Enhanced understanding of caffeine metabolism may lead to more refined respiratory management strategies.