Related Experiment Video
Updated: Nov 8, 2025
Early Pathological and Magnetic Resonance Detection of Cerebral Injury Using a Rat Model of Neonatal Hypoxic Ischemic Encephalopathy
Published on: October 28, 2022
Effects of Different Onset Times of Early Caffeine Treatment on Mesenteric Tissue Oxygenation and Necrotizing
Hilal Ozkan1, Merih Cetinkaya2, Salih C Cakir1
1Division of Neonatology, Department of Pediatrics, Bursa Uludag University Faculty of Medicine, Bursa, Turkey.
Insights
Early caffeine treatment in premature infants, especially within the first 24 hours, may increase necrotizing enterocolitis (NEC) risk by reducing mesenteric blood flow. Mesenteric oxygen saturation monitoring can help predict NEC development.
Area of Science:
- Neonatal Medicine
- Pediatric Surgery
- Clinical Research
Background:
- Caffeine is standard for premature infants to prevent apnea and bronchopulmonary dysplasia.
- Concerns exist regarding early caffeine's potential to cause necrotizing enterocolitis (NEC) by reducing mesenteric blood flow.
- The impact of caffeine treatment onset timing on NEC and mesenteric perfusion is debated.
Purpose of the Study:
- To investigate the effect of different early caffeine treatment onset times on mesenteric tissue oxygen saturation.
- To determine the association between caffeine treatment timing and the development of NEC in preterm infants.
- To explore the predictive value of mesenteric oxygenation measurements for NEC.
Main Methods:
- Prospective study of 87 preterm infants (≤1,250g BW).
- Infants randomized into two groups: caffeine within 24 hours (Group 1) or at 72 hours (Group 2).
- Mesenteric tissue oxygen saturation (rSO2) monitored via NIRS for 72 hours; follow-up to 40 weeks for NEC and morbidities.
Main Results:
- NEC incidence was 20% in Group 1 versus 9% in Group 2.
- Mesenteric rSO2 values were significantly lower in Group 1 compared to Group 2 during the first 72 hours.
- Low gestational age, birth weight, and delayed enteral feeding were identified as other NEC risk factors.
Conclusions:
- Earlier caffeine treatment (within 24 hours) was associated with lower mesenteric oxygenation and higher NEC rates.
- Mesenteric rSO2 monitoring may aid in predicting NEC risk in infants receiving early caffeine therapy.
- The timing of initiating caffeine treatment warrants careful consideration in preterm neonates.
Objective:
Caffeine treatment is routinely used in premature infants to prevent development of apnea and bronchopulmonary dysplasia. Although a limited number of studies have reported that early caffeine treatment may cause development of necrotizing enterocolitis (NEC) by reducing mesenteric blood flow, this issue is still under discussion. The aim of this study is to investigate the possible effect of different onset times of early caffeine treatment on mesenteric tissue oxygen saturation and NEC development in premature infants.
Study Design:
A total of 87 preterm infants with ≤1,250-g birth weight (BW) was included in this prospective study. The cases were randomized as group 1 (first 24 hours) and group 2 (72nd hour) caffeine treatment groups and monitored by near-infrared spectroscopy (NIRS) for 72 hours from the time of admission until cerebral, renal, and mesenteric tissue oxygen saturations (rSO2) were recorded. The cases were followed-up to the 40th week in terms of NEC and other neonatal morbidities.
Results:
A total of 87 infants were included in the study, including 45 in group 1 and 42 in group 2. The groups were similar in terms of demographic characteristics. The incidence of NEC in group 1 (20%) was higher in comparison to group 2 (9%). The mesenteric rSO2 values in the first 72 hours of group 1 were lower than those of group 2. Low gestational week, BW, and late onset of enteral feeding were found to be other significant risk factors for NEC.
Conclusion:
In this study, mesenteric tissue oxygenation was lower, and NEC was higher in group 1. Mesenteric rSO2 measurements may be useful in predicting the development of NEC in patients receiving early caffeine therapy.
Key Points:
· Onset time of early caffeine treatment may effect on mesenteric tissue oxygen saturation.. · Caffeine treatment that onset in the first 24 hours may be associated with NEC development.. · Mesenteric rSO2 measurements may be useful in patients receiving early caffeine therapy..
