Early Caffeine Prophylaxis and Risk of Failure of Initial Continuous Positive Airway Pressure in Very Low Birth Weight Infants

Abstract

Objective To test the hypothesis that early caffeine treatment on the day of birth, compared with later treatment in very low birth weight (VLBW, <1500 g) infants receiving continuous positive airway pressure (CPAP) therapy, is associated with a decreased risk of CPAP failure in the first week of life. Study design Multicenter, observational cohort study in 366 US neonatal intensive care units. We evaluated inborn, VLBW infants discharged from 2000 to 2014, who received only CPAP therapy without surfactant treatment on day of life (DOL) 0, had a 5-minute Apgar ≥3, and received caffeine in first week of life. We used multivariable conditional logistic regression to compare the risk of CPAP failure, defined as invasive mechanical ventilation or surfactant therapy on DOL 1-6, by timing of caffeine treatment as either early (initiation on DOL 0) or routine (initiation on DOL 1-6). Results We identified 11 133 infants; 4528 (41%) received early caffeine and 6605 (59%) received routine caffeine. Median gestational age was lower in the early caffeine group, 29 weeks (25th, 75th percentiles; 28, 30) vs the routine caffeine group, 30 weeks (29, 31); P < 0.001. The incidence of CPAP failure on DOL 1-6 was similar between the early and routine caffeine groups: 22% vs 21%; adjusted OR = 1.05 (95% CI: 0.93, 1.18). Conclusions Early caffeine treatment on the day of birth was not associated with a decreased risk of CPAP failure in the first week of life for VLBW infants initially treated with CPAP.

Caffeine citrate improves outcomes of apnea of prematurity based on gestational ages

“…In recent years, it has been suggested that premature infants can be benefited from earlier using of caffeine, which was associated with improved hemodynamics (28) and reduced incidence and severity of acute kidney injury (29,30). Early caffeine using was associated with improved blood pressure and systemic blood flow, and heart rate, left ventricular output, and stroke volume were not significantly affected.…”

Caffeine in preterm infants: where are we in 2020?

“…Contrasting results on early caffeine administration A retrospective analysis conducted by PATEL et al [73] on VLBW infants (birthweight <1500 g) receiving initial CPAP (on day of life 0) compared the effect of early caffeine (day of life 0) versus routine caffeine (day of life 1-6). The results demonstrated no difference in CPAP failure defined as invasive mechanical ventilation or surfactant therapy on day of life 1-6 (22% versus 21%, adjusted odds ratio (aOR) 1.05), in exposure to a maximal inspiratory oxygen fraction >0.3 in the first week of life (27% versus 32%, aOR 1.05) and in the total duration of CPAP therapy (median 3 versus 2 days, aOR 1.02).…”

Is earlier better when it comes giving caffeine to preterm infants or are we risking unnecessary treatment and serious harm?

“…Starting caffeine in the first day of life increased from 21% in 2000 to 67% in 2014. 4 It has been suggested that all extremely preterm infants should receive caffeine in the very first minute of life to minimise the risk of intubation, in association with surfactant administration during non-invasive respiratory support. 5 But is earlier caffeine treatment better in very preterm infants?…”