Very Early (<2 h) Versus Early (12 h) Administration of Caffeine Citrate for Reducing Need for Mechanical Ventilation within 24 h of Life in Preterm Infants on Continuous Positive Airway Pressure
Abstract
Background and Objective: In the caffeine for apnea of prematurity (CAP) trial, post hoc analyses have discovered reductions in respiratory and neurologic morbidities associated with earlier caffeine initiation (within 3 days). This study aims to compare the effects of early (<2 h) and late (12 h) initiation of caffeine in preterm neonates on continuous positive airway pressure (CPAP).
Study Design: A total of 36 neonates <32 weeks gestational age were randomized to receive intravenous caffeine citrate (20 mg/kg) before 2 h (early n = 19) or at 12 h of age (late n = 17). This was a pilot randomized controlled trial to determine the power needed to reduce the need for endotracheal intubation by 24 h of age. Other outcomes included the duration of respiratory support, duration of oxygen therapy, need for vasopressors, incidence of intraventricular hemorrhage, patent ductus arteriosus needing treatment, necrotizing enterocolitis, bronchopulmonary dysplasia, retinopathy of prematurity, sepsis, and mortality.
Results: There was no difference in the need for intubation (P = 0.615) or vasopressors (P = 0.455) by 24 h of age. Statistically significant reduction was noted in the total duration of CPAP support (P = 0.003). However, total duration of respiratory support (P = 0.425), total duration of mechanical ventilation days (P = 0.237), and oxygen days (P = 0.145) were favoring early caffeine group, which were not statistically significant. None of the babies in both the groups had apnea of prematurity. There was no difference in other outcomes.
Conclusion: This pilot study demonstrated the feasibility of conducting such a trial in very preterm neonates. We found that early caffeine administration was associated with statistically significant reduction in the duration of non-inWvasive respiratory support. Larger studies are needed to determine whether early caffeine reduces intubation, intraventricular hemorrhage, duration of respiratory support, and related long-term outcomes.
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