Effect of very early use of caffeine citrate in preterm neonates needing respiratory support

Abstract

Background Caffeine citrate is one of the most widely used medications in neonatal intensive care units. It is a respiratory stimulant which has well established therapeutic effects in apnea and extubation. Little is known about the very early use of caffeine citrate in preterm neonates. We aim to explore the effectiveness of its very early use in reducing the duration of the respiratory support used and not just extubation. Objectives to study the effect of the very early use of caffeine citrate in preterm neonates on morbidity and short-term neonatal outcomes. Subjects and Methods A prospective phase 3 clinical trial was carried out on 54 preterm neonates less than 34 weeks of gestation who require respiratory support and were given caffeine citrate in two different settings, over a period of one year. Patients were randomly allocated to one of two groups, the first group was given caffeine citrate at initiation of respiratory support(CPAP, NIPPV and IPPV). The second group received caffeine citrate 6 hours before weaning of the respiratory support used. Caffeine citrate was stopped after complete removal of the respiratory support used. Both groups were compared as regard the duration of each respiratory support used separately and the total duration of respiratory support needed for each patient. Results The duration of IPPV used in patients was significantly lower in the patients that received early caffeine citrate. Total duration of the respiratory support needed for each patient was significantly lower in the early group. There was no significant difference in the development of complications related to the drug use between both groups. The total duration of NICU stay was significantly lower in the early group than the other group. Conclusion The Early initiation of caffeine citrate has effectively and safely decreased duration of respiratory support used and NICU stay without the development of any complications. Key words early caffeine citrate, preterm neonates, respiratory support. *CPAP: Continuous positive airway pressure NIPPV: Non invasive positive pressure ventilation IPPV: Intermittent positive pressure ventilation NICU: Neonatal Intensive care unit

Caffeine reduces oxidative stress to protect against hyperoxia-induced lung injury via the adenosine A2A receptor/cAMP/PKA/Src/ERK1/2/p38MAPK pathway

“…Early initiation of caffeine therapy can not only reduce the incidence of BPD [ 9 ] but also improve long-term lung function [ 23 ]. A prospective phase 3 clinical trial indicated the early initiation of caffeine has effectively and safely decreased duration of respiratory support used and ICU stay without the development of any complications [ 24 ]. A retrospective study showed that high dose caffeine may provide additional benefit in reducing the risk of bronchopulmonary dysplasia and extubation failure, but may also increase the risk of cerebellar hemorrhage and seizures [ 25 ].…”

Weaning and extubation from neonatal mechanical ventilation: an evidenced-based review

“…Another clinical trial published in 2021 reported different results. According to this study, caffeine administration at the initiation of mechanical ventilation accelerated extubation without causing complications [ 60 ]. This variation in results is also seen in other cohort studies, and it seems that clinical trials with larger studied populations and longer follow-up times may help determine the optimal use of caffeine.…”