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National and international guidelines for neonatal caffeine use: Are they evidenced-based?

Eric C Eichenwald1

  • 1Thomas Frederick McNair Scott Endowed Chair, Professor of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Chief, Division of Neonatology, Children's Hospital of Philadelphia, USA.

Seminars in Fetal & Neonatal Medicine
|November 20, 2020
PubMed

Insights

Caffeine citrate is safe and beneficial for preterm infants, improving lung and brain function. Current guidelines suggest early prophylactic use, sometimes at higher doses than initially studied.

Area of Science:

  • Neonatology
  • Pharmacology
  • Pediatric Pulmonology

Background:

  • The Caffeine for Apnea of Prematurity (CAP) trial established caffeine citrate's safety and efficacy.
  • Caffeine use in extremely premature infants is now widespread in Neonatal Intensive Care Units globally.
  • Observational studies suggest earlier administration, before 3 days of age, may enhance benefits.

Purpose of the Study:

  • To review the evidence supporting neonatal caffeine therapy.
  • To evaluate current guidelines recommending prophylactic caffeine use and higher dosages.
  • To contextualize the CAP trial findings with contemporary clinical practices.

Main Methods:

  • Review of the Caffeine for Apnea of Prematurity (CAP) trial data.
  • Analysis of subsequent observational studies on early caffeine administration.
  • Examination of national and international clinical practice guidelines for neonatal caffeine therapy.

Main Results:

  • The CAP trial demonstrated pulmonary and neurological benefits of caffeine in preterm infants.
  • Widespread adoption of caffeine therapy in extremely premature infants.
  • Emergence of guidelines advocating prophylactic use and higher doses than in the CAP trial.

Conclusions:

  • Neonatal caffeine therapy, particularly caffeine citrate, remains a cornerstone in managing preterm infants.
  • The evidence base for current prophylactic strategies and higher dosing requires critical review.
  • Aligning clinical practice with robust scientific evidence is crucial for optimizing infant outcomes.

Keywords:
ApneaBronchopulmonary dysplasiaCaffeineClinical trialDrug safetyNeurodevelopmentPrematurity

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