Early Caffeine and Weaning from Mechanical Ventilation in Preterm Infants: A Randomized, Placebo-Controlled Trial

Amaro, Cynthia M.; Bello, Jose A.; Jain, Deepak; Ramnath, A; D'Ugard, Carmen; Vanbuskirk, Silvia; Bancalari, Eduardo; Claure, Nelson

doi:10.1016/j.jpeds.2018.01.010

Cited by 57 publications

(62 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…McPherson et al document an increased risk of cerebellar hemorrhage, without measurable improvement in white matter maturation among a cohort of extremely preterm infants analogous to the PROP population. Furthermore, Amaro et al document that early initiation of caffeine did not reduce the age of first successful extubation and halted their trial before completion due to a nonsignificant trend toward higher mortality in the early caffeine group. The practice drift identified in PROP raises concern and justifies continued research regarding caffeine therapy beyond the parameters of the CAP trial.…”

Section: Discussionmentioning

confidence: 99%

Respiratory medication use in extremely premature (<29 weeks) infants during initial NICU hospitalization: Results from the prematurity and respiratory outcomes program

Greenberg

Poindexter

Shaw

et al. 2019

Pediatric Pulmonology

View full text Add to dashboard Cite

Background The use of medications to treat respiratory conditions of extreme prematurity is often based upon studies of adults or children over 2 years of age. Little is known about the spectrum of medications used or dosing ranges. To inform the design of future studies, we conducted a prospective analysis of respiratory medication exposure among 832 extremely low gestational age neonates. Methods The prematurity and respiratory outcomes program (PROP) enrolled neonates less than 29‐week gestation from 6 centers incorporating 13 clinical sites. We collected recorded daily “respiratory” medications given along with dosing information through 40‐week postmenstrual age or neonatal intensive care unit discharge if earlier. Results PROP participants were exposed to a wide range of respiratory medications, often at doses beyond published recommendations. Nearly 50% received caffeine and furosemide beyond published recommendations for cumulative dose. Those who developed bronchopulmonary dysplasia were more likely to receive treatment with respiratory medications. However, more than 30% of PROP subjects that did not develop bronchopulmonary dysplasia also were treated with diuretics, systemic steroids, and other respiratory medications. Conclusion Extremely preterm neonates in PROP were exposed to high doses of medications at levels known to generate significant adverse effects. With limited evidence for efficacy, there is an urgent need for controlled trials in this vulnerable patient population.

show abstract

Section: Discussionmentioning

confidence: 99%

Respiratory medication use in extremely premature (<29 weeks) infants during initial NICU hospitalization: Results from the prematurity and respiratory outcomes program

Greenberg

Poindexter

Shaw

et al. 2019

Pediatric Pulmonology

View full text Add to dashboard Cite

show abstract

“…In this cohort, at age 11 years the caffeine-treated children had better respiratory function [127] and reduced risk of motor impairment [128]. Caffeine prophylaxis soon after admission has become standard based on cohort studies showing that earlier initiation of caffeine is associated with better outcomes [129]; however, a clinical trial of prophylactic caffeine versus placebo was abandoned early because of perceived worse outcome in the caffeine-treated group [130]. The standard dosing regimen of caffeine citrate is loading with 20 mg/kg followed by maintenance of 5–10 mg/kg/day.…”

Section: Strategiesmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

et al. 2019

View full text Add to dashboard Cite

As management of respiratory distress syndrome (RDS) advances, clinicians must continually revise their current practice. We report the fourth update of “European Guidelines for the Management of RDS” by a European panel of experienced neonatologists and an expert perinatal obstetrician based on available literature up to the end of 2018. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, need for appropriate maternal transfer to a perinatal centre and timely use of antenatal steroids. Delivery room management has become more evidence-based, and protocols for lung protection including initiation of CPAP and titration of oxygen should be implemented immediately after birth. Surfactant replacement therapy is a crucial part of management of RDS, and newer protocols for its use recommend early administration and avoidance of mechanical ventilation. Methods of maintaining babies on non-invasive respiratory support have been further developed and may cause less distress and reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation using caffeine and, if necessary, postnatal steroids are also important considerations. Protocols for optimising general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome.

show abstract

“…R e c i e n t e s t r a b a j o s p l a n t e a n a u n m á s interrogantes. 4 Por un lado, el uso de cafeína de forma precoz, buscando una extubación exitosa y, además, menor incidencia de DBP, no demostró mejorar los resultados de estos desenlaces. Por otro lado, el trabajo tuvo que ser suspendido por el aumento de la mortalidad por encima del histórico de la institución donde se realizaba la intervención.…”

Section: Cafeína En Prematuros De Lo Mágico a Las Incertidumbresunclassified

Cafeína en prematuros. De lo mágico a las incertidumbres

2018

Arch Argent Pediatr

View full text Add to dashboard Cite

Early Caffeine and Weaning from Mechanical Ventilation in Preterm Infants: A Randomized, Placebo-Controlled Trial

Cited by 57 publications

References 10 publications

Respiratory medication use in extremely premature (<29 weeks) infants during initial NICU hospitalization: Results from the prematurity and respiratory outcomes program

Respiratory medication use in extremely premature (<29 weeks) infants during initial NICU hospitalization: Results from the prematurity and respiratory outcomes program

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

Cafeína en prematuros. De lo mágico a las incertidumbres

Contact Info

Product

Resources

About