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Caffeine for Persistent Intermittent Hypoxia in Newborns With and Without Chronic Lung Disease
Aurore Côté1, Phoukim Savanh2, Wissam Shalish3
1Respiratory Medicine Division, Room B-RC-5155, The Montreal Children's Hospital, Montreal, Québec, Canada.
Insights
Caffeine effectively improved respiratory outcomes in preterm and term newborns with persistent intermittent hypoxia (IH), including those with chronic lung disease of prematurity (CLD). Most infants responded well, enabling successful discontinuation of caffeine treatment.
Area of Science:
- Neonatal Medicine
- Respiratory Physiology
- Pharmacology
Background:
- Persistent intermittent hypoxia (IH) is a common respiratory challenge in preterm and term newborns.
- Chronic lung disease of prematurity (CLD) complicates IH management and response to treatment.
- Assessing caffeine's efficacy in IH is crucial for optimizing respiratory support before discharge.
Purpose of the Study:
- To evaluate the caffeine response in preterm and term infants experiencing persistent IH.
- To specifically analyze caffeine's effect on newborns with CLD.
- To identify factors associated with a non-response to caffeine therapy.
Main Methods:
- Retrospective cohort study conducted in two neonatal intensive care units from 2015 to 2022.
- Inclusion of preterm and term infants with persistent IH requiring caffeine treatment.
- Analysis of respiratory parameters including oxygen saturation (SpO2) and carbon dioxide levels (PCO2) before and after caffeine administration.
Main Results:
- Caffeine administration led to normal oximetry in 81% of CLD infants, 96% of preterm non-CLD infants, and 96% of term infants.
- Significant reductions were observed in % time with SpO2 < 90%, desaturation index < 80%, and desaturation index ≥ 10% lasting > 10s.
- 74% of infants on respiratory support were weaned, and 63% with elevated PCO2 normalized their levels post-caffeine.
Conclusions:
- Caffeine significantly improves respiratory outcomes in the majority of preterm and term infants with persistent IH.
- The treatment is effective even in infants with CLD, a population often facing more complex respiratory issues.
- Caffeine therapy facilitates respiratory support weaning and normalization of gas exchange, contributing to successful discharge preparation.
Objectives:
To assess the caffeine response in preterm and term newborns with persistent intermittent hypoxia (IH) as they approach discharge, with particular focus on newborns with chronic lung disease of prematurity (CLD). To identify factors associated with a lack of response to caffeine.
Design/Settings:
Retrospective cohort study across two neonatal intensive care units between 2015 and 2022.
Main Outcomes Following Caffeine Administration:
Normal oximetry; no need for respiratory support; resolution of hypercapnia.
Results:
A total of 132 infants received caffeine for persistent IH. Normal oximetry was achieved post-caffeine in 81% (46/57) of newborns with CLD, in 96% (46/48) of preterm with no CLD, in 96% (26/27) of term newborns. Caffeine reduced the % time with SpO2 < 90% from 6.8% (interquartile range, 3.8%-12.2%), to 0.8% (0.4%-1.6%, p < 0.0001). The desaturation index < 80% dropped from 5.3 events/hour (0.9-14.6 events/hour) to 0.2 events/hour (0-0.78 events/hour, p < 0.0001) and the desaturation index ≥ 10% lasting > 10 s went from 6.6 events/hour (3.3-10.7 events/hour) to 1.4 events/hour (0.7-2.4 events/hour, p < 0.0001). Of the 61 infants on respiratory support, 74% (45/61) were weaned within a few days following caffeine. Caffeine normalized PCO2 in 63% (41/65) of newborns with elevated PCO2 pre-caffeine. Infants failing caffeine were more likely to have CLD compared to responders (79% vs. 39%, p < 0.005). Caffeine was successfully discontinued (first attempt, normal oximetry) in 101 infants (88%) at postmenstrual age of 46.1 weeks (45.3-48.3 weeks).
Conclusion:
Caffeine improved respiratory outcomes in the majority of preterm and term born infants with persistent IH, including those with CLD.
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