Caffeine for Apnea of Prematurity Trial: Benefits May Vary in Subgroups

Davis, Peter G; Schmidt, Barbara; Roberts, Robin S.; Doyle, Lex W.; Asztalos, Elizabeth; Haslam, Ross; Sinha, Sunil K.; Tin, Win

doi:10.1016/j.jpeds.2009.09.069

Cited by 207 publications

(152 citation statements)

References 11 publications

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“…First, we did not assess whether even shorter oxygen exposure times were sufficient to cause sustained inflammation, as suggested by the randomised controlled trial of VENTO et al [6]. Secondly, caffeine was given only once to the animals, while preterm infants receive caffeine for many weeks [10]. Thirdly, caffeine is thought to exert most of its actions via competitive nonspecific antagonism of ARs [32,33], and investigating the involvement of these receptors has been beyond the focus of our experiments.…”

Section: Discussionmentioning

confidence: 98%

“…The protective effect was greatest when the administration of caffeine was started early, i.e. during the first 3 days of life [10]. The protective role of caffeine has been attributed to improved respiratory muscle strength and reduced rates of apnoea [11], which lead to reduced ventilator-induced lung injury and decreased requirement for mechanical ventilation.…”

mentioning

confidence: 99%

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Prevention of hyperoxia-mediated pulmonary inflammation in neonatal rats by caffeine

et al. 2012

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In preterm human infants, briefly elevated concentrations of oxygen are associated with a prolonged increase in blood chemokine concentrations and the development of bronchopulmonary dysplasia (BPD). Caffeine given to preterm infants for the prevention or treatment of apnoea has been shown to reduce the rate of BPD.We tested the hypotheses that infant rats exposed to a combination of caffeine and hyperoxia would be less susceptible to lung injury than those exposed to hyperoxia alone and that caffeine decreases the pulmonary tissue expression of chemokines and leukocyte influx following hyperoxia.Using 6-day-old rat pups, we demonstrated that 24 h of 80% oxygen exposure caused pulmonary recruitment of neutrophils and macrophages. High levels of oxygen upregulated the expression of: the CXC chemokines, cytokine-induced neutrophil chemoattractant-1 and macrophage inflammatory protein-2; the CC-chemokine monocyte chemoattractant protein-1; the pro-inflammatory cytokines tumour necrosis factor-a and interleukin-6, as measured by realtime PCR after the administration of caffeine (10 mg?kg -1 body weight); and attenuated chemokine and cytokine upregulation, as well as the influx of CD11b + , ED-1 + and myeloperoxidase + leukocytes.These experiments suggest that protective effects of caffeine in the neonatal lung are mediated, at least in part, by reduction of pulmonary inflammation.

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Section: Discussionmentioning

confidence: 98%

mentioning

confidence: 99%

Prevention of hyperoxia-mediated pulmonary inflammation in neonatal rats by caffeine

et al. 2012

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“…20 In the Caffeine for Apnea of Prematurity Trial, earlier treatment with caffeine (<3 days) compared with later (≥3 days) was associated with a shorter duration of mechanical ventilation, although it is not clear whether infants started earlier on caffeine were assessed to be more likely to be extubated soon. 21 In a retrospective cohort study in 62 056 infants with very low birth weight discharged between 1997 and 2010, early caffeine therapy compared with later therapy was associated with a lower incidence of bronchopulmonary dysplasia (23.1% vs 30.7%; odds ratio: 0.68; 95% confidence interval: 0.69-0.80) as well as a shorter duration of mechanical ventilation (mean difference: 6 days; P < .001). 22 Further trials are needed to assess the safety and the potential benefits of early prophylactic caffeine in infants who require mechanical ventilation.…”

Section: Monitoring For Apnea/ Bradycardiamentioning

confidence: 97%

Apnea of Prematurity

2016

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Apnea of prematurity is one of the most common diagnoses in the NICU. Despite the frequency of apnea of prematurity, it is unknown whether recurrent apnea, bradycardia, and hypoxemia in preterm infants are harmful. Research into the development of respiratory control in immature animals and preterm infants has facilitated our understanding of the pathogenesis and treatment of apnea of prematurity. However, the lack of consistent defi nitions, monitoring practices, and consensus about clinical signifi cance leads to signifi cant variation in practice. The purpose of this clinical report is to review the evidence basis for the defi nition, epidemiology, and treatment of apnea of prematurity as well as discharge recommendations for preterm infants diagnosed with recurrent apneic events.

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“…They also improve respiratory muscle strength. Therapy with caffeine has proven to reduce the duration of artificial ventilation and oxygen demand and decrease risk for bronchopulmonary dysplasia (BPD) and the need for patent ductus arteriosus (PDA) ligation [23,24]. At the age of 2 years, positive effects on cognitive development were observed, but in the same group of children at the age of 5 years they were no longer detected [25].…”

Section: Methylxanthinesmentioning

confidence: 99%

Respiratory Care of the Neonate

Grosek¹,

Fister²

2018

Selected Topics in Neonatal Care

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The respiratory distress is a very common condition both in term and in preterm neonates and the most frequent reason for admission to the neonatal intensive care unit (NICU). The aetiology greatly depends on the maturation of neonate's organs and perinatal events. The clinical picture is sometimes scarce and very nonspecific for the etiologic determination. Treatment of neonatal RD begins first with the application of a mixture of oxygen and air, then with different modes of non-invasive respiratory support methods. Non-invasive respiratory support can be sustained with nasal continuous positive airway pressure, bi-level positive airway pressure and high-flow nasal cannula ventilation. Non-invasive ventilation with high-frequency oscillations through nasal cannula or masks is also possible with some respiratory devices. Non-invasive ventilation is usually combined with the application of natural surfactant and other therapeutic means, like methylxanthine therapy, prevention and closure of patent ductus arteriosus, and control of infection. In the case of non-invasive ventilation failure, different kinds of invasive ventilation methods are available and being practiced in NICUs. The invasive respiratory support can be maintained by controlled or intermittent mandatory ventilation combined with different supportive synchronous positive inspiratory ventilation, offered by modern respirators.

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Caffeine for Apnea of Prematurity Trial: Benefits May Vary in Subgroups

Cited by 207 publications

References 11 publications

Prevention of hyperoxia-mediated pulmonary inflammation in neonatal rats by caffeine

Prevention of hyperoxia-mediated pulmonary inflammation in neonatal rats by caffeine

Apnea of Prematurity

Respiratory Care of the Neonate

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