A Randomized Controlled Trial Comparing Two Doses of Caffeine for Apnoea in Prematurity

Kori, Anis Munirah Mohd; Rostenberghe, Hans Van; Ibrahim, Nor Rosidah; Yaacob, Najib Majdi; Nasir, Ariffin

doi:10.3390/ijerph18094509

Cited by 8 publications

(4 citation statements)

References 20 publications

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“…In this systematic review and meta-analysis of 221 trials that assessed 44 perinatal interventions, we found with moderate certainty that antenatal corticosteroids for lung maturation (small decrease) and indomethacin prophylaxis (moderate decrease) were associated with reduced risk of sIVH in preterm neonates. We also found low certainty evidence that volume-targeted ventilation (large decrease), early ESAs (moderate decrease), and prophylactic ethamsylate (moderate decrease) were associated with lower risk of sIVH, whereas UCM (moderate increase) were associated with higher risk of sIVH in preterm neonates.…”

Section: Discussionmentioning

confidence: 93%

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Interventions to Reduce Severe Brain Injury Risk in Preterm Neonates

et al. 2023

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ImportanceInterventions to reduce severe brain injury risk are the prime focus in neonatal clinical trials.ObjectiveTo evaluate multiple perinatal interventions across clinical settings for reducing the risk of severe intraventricular hemorrhage (sIVH) and cystic periventricular leukomalacia (cPVL) in preterm neonates.Data SourcesMEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases were searched from inception until September 8, 2022, using prespecified search terms and no language restrictions.Study SelectionRandomized clinical trials (RCTs) that evaluated perinatal interventions, chosen a priori, and reported 1 or more outcomes (sIVH, cPVL, and severe brain injury) were included.Data Extraction and SynthesisTwo co-authors independently extracted the data, assessed the quality of the trials, and evaluated the certainty of the evidence using the Cochrane GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Fixed-effects pairwise meta-analysis was used for data synthesis.Main Outcomes and MeasuresThe 3 prespecified outcomes were sIVH, cPVL, and severe brain injury.ResultsA total of 221 RCTs that assessed 44 perinatal interventions (6 antenatal, 6 delivery room, and 32 neonatal) were included. Meta-analysis showed with moderate certainty that antenatal corticosteroids were associated with small reduction in sIVH risk (risk ratio [RR], 0.54 [95% CI, 0.35-0.82]; absolute risk difference [ARD], −1% [95% CI, −2% to 0%]; number needed to treat [NNT], 80 [95% CI, 48-232]), whereas indomethacin prophylaxis was associated with moderate reduction in sIVH risk (RR, 0.64 [95% CI, 0.52-0.79]; ARD, −5% [95% CI, −8% to −3%]; NNT, 20 [95% CI, 13-39]). Similarly, the meta-analysis showed with low certainty that volume-targeted ventilation was associated with large reduction in risk of sIVH (RR, 0.51 [95% CI, 0.36-0.72]; ARD, −9% [95% CI, −13% to −5%]; NNT, 11 [95% CI, 7-23]). Additionally, early erythropoiesis-stimulating agents (RR, 0.68 [95% CI, 0.57-0.83]; ARD, −3% [95% CI, −4% to −1%]; NNT, 34 [95% CI, 22-67]) and prophylactic ethamsylate (RR, 0.68 [95% CI, 0.48-0.97]; ARD, −4% [95% CI, −7% to 0%]; NNT, 26 [95% CI, 13-372]) were associated with moderate reduction in sIVH risk (low certainty). The meta-analysis also showed with low certainty that compared with delayed cord clamping, umbilical cord milking was associated with a moderate increase in sIVH risk (RR, 1.82 [95% CI, 1.03-3.21]; ARD, 3% [95% CI, 0%-6%]; NNT, −30 [95% CI, −368 to −16]).Conclusions and RelevanceResults of this study suggest that a few interventions, including antenatal corticosteroids and indomethacin prophylaxis, were associated with reduction in sIVH risk (moderate certainty), and volume-targeted ventilation, early erythropoiesis-stimulating agents, and prophylactic ethamsylate were associated with reduction in sIVH risk (low certainty) in preterm neonates. However, clinicians should carefully consider all of the critical factors that may affect applicability in these interventions, including certainty of the evidence, before applying them to clinical practice.

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Section: Discussionmentioning

confidence: 93%

“…We further determined the eligibility of 395 short-listed articles and excluded 174 articles for the reasons shown in eAppendix 4 in Supplement 1. A total of 221 RCTs were included in the final sample . These trials evaluated 44 interventions, which included 6 antenatal, 6 delivery room, and 32 neonatal interventions.…”

Section: Resultsmentioning

confidence: 99%

Interventions to Reduce Severe Brain Injury Risk in Preterm Neonates

et al. 2023

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“…Finally, it was seen that this treatment was not associated with significant adverse effects or that impact on the patient's quality of life (Du et al, 2020;Miao. et al, 2023;Kori et al, 2021).…”

Section: Side Effects and Associated Risksmentioning

confidence: 98%

“…These episodes in recent Premature births generally occur between the third and seventh day of life in babies who have respiratory distress syndrome (Elmowafi et al, 2021). It is possible to say that episodes do not controlled, prolonged and repeated apnea followed by hypoxia and bradycardia in the newborn can lead to numerous problems, such as the increased need for mechanical ventilation, difficulties in extubation and longer hospital stay (Guo et al, 2022;Kori et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Use of caffeine for managing apneia of premature

Jucá Neto,

Brasil,

Mendonça

et al. 2024

RSD

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Apnea of prematurity is a common diagnosis in neonatal intensive care units, especially in preterm patients under 35 weeks or patients born with low birth weight (<1500g). From this perspective, the use of caffeine citrate has short and long-term benefits in this pathology, in addition to reducing the incidence of complications. Methodology: A narrative review of the literature was carried out using the PUBMED database, using the following keywords: “Apnea Prematurity”, “Caffeine” and “Treatment”, with a 6-year filter, analyzing 164 articles, of which only 34 were included and 130 were excluded. Results and Discussion: Apnea of prematurity is a common pathology in preterm and extremely preterm infants, with an incidence of 10% of newborns after 34 weeks and 20-85% of newborns born between 30-34 weeks. The pathophysiology of the disease is explained by the immaturity of the central nervous system in maintaining respiratory drive, in addition to impaired sensitivity in response to chemoreceptors and difficulty in maintaining REM sleep, in addition to the chronic losses inherent to chronic hypoxia. Methylxanthines, the active ingredient in caffeine, have the activation mechanism of inhibiting adenosine A1 and A2 receptors coupled to G protein. The recommended initial dose for therapy is 10 mg/kg for apnea of prematurity, but it must be monitored with concentrations serum levels of the drug to a safe therapeutic range, in addition to monitoring side effects in view of the patient's clinical impairment. The main signs of side effects from the use of caffeine are tachycardia, hyperglycemia, reduced growth rate, jaundice, irritability, agitation and convulsions. Conclusion: Apnea of prematurity is a very prevalent pathology in preterm newborns and its therapeutic possibility must be taken into account in view of its possible short and long-term complications, since the use of methylxanthines has different evidence of clinical improvement.

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