Early caffeine therapy on the prevention of severe hyperkalemia in preterm infants

The aim of this study was to evaluate the effect of caffeine therapy in preventing severe hyperkalemia in preterm infants.

We performed a single-center, retrospective study of preterm infants of 25-29 weeks' gestation admitted in our neonatal intensive care unit from January 2019-August 2020. We divided the infants into two groups: the control group (January 2019-November 2019) and the early caffeine group (December 2019-August 2020).

We identified 33 infants (early caffeine, 15; control, 18). Baseline potassium levels were 5.3 and 4.8 mEq/L, respectively (p = 0.274). Severe hyperkalemia (K > 6.5 mEq/L) was observed in 0 (0%) and 7 (39%) (p = 0.009), in the early caffeine group and control group. The linear mixed-effect model confirmed the correlation between caffeine therapy and time from birth for the prediction of potassium levels (p < 0.001). While the potassium levels increased from baseline potassium levels at birth by 0.869 mEq/L at 12 h of birth, 0.884 mEq/L at 18 h of birth, and 0.641 mEq/L at 24 h of birth in the control group, the potassium levels were similar to the baseline levels at 12, 18, and 24 h of life in the early caffeine group. Among the clinical features, only early caffeine therapy was negatively associated with the incidence of hyperkalemia within 72 h of life.

Early caffeine therapy within a few hours of life effectively prevents the incidence of severe hyperkalemia within the first 72 h of life in preterm infants of 25-29 weeks' gestation. Prophylactic early caffeine therapy can, therefore, be considered in high-risk, preterm infants.