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Dose-Response Study of Caffeine on Postnatal Weight Gain in Premature Neonates-A Retrospective Cohort Study

Ijaz Hussain1, Manoj Kumar1, Amin Ali2

  • 1Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan.

Dose-Response : a Publication of International Hormesis Society
|April 15, 2024
PubMed

Insights

Higher caffeine doses in premature neonates are linked to reduced weight gain and increased side effects. Standard caffeine citrate (CC) regimens support better growth than higher doses, which may have catabolic effects.

Area of Science:

  • Neonatalogy
  • Pharmacology
  • Pediatric Medicine

Background:

  • Caffeine citrate (CC) administration in premature neonates can lead to increased energy expenditure, diuresis, natriuresis, and other side effects (CC-APSEs).
  • These CC-associated potential side effects (CC-APSEs) are linked to diminished daily weight gain (WG) in this vulnerable population.
  • The standard CC regimen is 5 mg/kg/day, but higher doses are sometimes used, necessitating an evaluation of their impact.

Purpose of the Study:

  • To evaluate the effect of higher caffeine citrate (CC) doses on mean daily weight gain (MD-WG) in premature neonates.
  • To assess the development of CC-associated potential side effects (CC-APSEs) at different CC dosage levels.
  • To compare outcomes between a standard CC dose (5 mg/kg/day) and higher doses (>5-7 mg/kg/day and >7 mg/kg/day).

Main Methods:

  • A retrospective cohort study involving 284 neonates with gestational age ≤36 weeks receiving CC therapy.
  • Participants were analyzed in two postnatal phases: 15-28 days of life (DOL) and 29-42 DOL.
  • Neonates were stratified into three groups based on daily CC dose: Group I (5 mg/kg/day), Group II (>5-7 mg/kg/day), and Group III (>7 mg/kg/day), with Group I serving as the standard for comparison.

Main Results:

  • During 15-28 DOL, MD-WG was significantly lower in Group II (17.5 ± .49 g/kg/d) and Group III (16.7 ± .71 g/kg/d) compared to Group I (19.9 ± .88 g/kg/d).
  • During 29-42 DOL, MD-WG remained significantly lower in Group III (18.1 ± .39 g/kg/d) versus Group I (21.5 ± .42 g/kg/d), while Group II was comparable to Group I.
  • CC-APSEs were significantly higher in Group II and Group III during 15-28 DOL, and significantly higher in Group III during 29-42 DOL.

Conclusions:

  • Higher caffeine citrate doses are associated with reduced postnatal weight gain in preterm neonates compared to standard regimens.
  • The increased catabolic effects and CC-APSEs at higher doses likely contribute to the observed lower weight gain.
  • Optimizing CC dosage is crucial for maximizing weight gain and minimizing adverse effects in premature infants.
Abstract

Keywords:
apnea of prematuritycaffeine citrateneonatesside effects

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