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Variation of caffeine use in late preterm infants in U.S. NICUs over time: A 12-year cohort study

Kristin E D Weimer1, Lakshmi Katakam2, Kevin Williams2

  • 1Department of Pediatrics, Duke University, Durham, NC, USA. kristin.weimer@duke.edu.

Journal of Perinatology : Official Journal of the California Perinatal Association
|June 22, 2026
PubMed

Insights

Caffeine use in late preterm infants (LPIs) requiring respiratory support has remained stable but prescribing practices have changed. LPIs in NICUs received caffeine earlier and for shorter durations in recent years.

Area of Science:

  • Neonatal Medicine
  • Pediatric Pharmacology
  • Respiratory Care

Background:

  • Late preterm infants (34-36 weeks gestation) often require respiratory support in Neonatal Intensive Care Units (NICUs).
  • Caffeine is a common medication used to manage apnea and support respiratory function in preterm infants.

Purpose of the Study:

  • To describe the trends and patterns of caffeine use in late preterm infants (LPIs) admitted to Neonatal Intensive Care Units (NICUs) over an 11-year period.
  • To analyze changes in caffeine prescribing practices for LPIs between two distinct time epochs.

Main Methods:

  • A cohort study analyzed data from 233,804 late preterm infants born between 34-36 weeks gestation.
  • Infants were discharged from Pediatrix Medical Group NICUs between 2011 and 2022.
  • Data were compared between two epochs: 2011-2016 and 2017-2022.

Main Results:

  • 3.7% of LPIs (n=8633) were exposed to caffeine.
  • Caffeine-exposed LPIs had lower gestational age, higher respiratory support needs, and longer hospital stays.
  • Between 2011-2016 and 2017-2022, caffeine initiation occurred earlier (2 vs. 3 days), duration was shorter (1 vs. 6 days), and discontinuation occurred at an earlier postmenstrual age (35 vs. 35.4 weeks).

Conclusions:

  • Caffeine is predominantly used in LPIs with lower gestational age and significant respiratory support requirements.
  • While the overall incidence of caffeine use in LPIs remained stable, prescribing practices evolved, with earlier initiation and shorter durations observed in recent years.
  • Differences in prescribing practices were noted across various sites and over time.
Abstract

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