Wide variation in caffeine discontinuation timing in premature infants

Abstract

Objective To assess site variability and concomitant respiratory support related to the timing of caffeine discontinuation, and compare clinical characteristics of infants who discontinued caffeine before vs. within the last week of hospitalization.Study design Cohort study of 81,110 infants <35 weeks gestational age and <1500 g birth weight discharged from 304 neonatal intensive care units from 2001-2016. ResultsThe mean postmenstrual age at caffeine discontinuation ranged from 32 to 37 weeks among sites. Respiratory support at the time of discontinuation was common, but variable, with 0-57% of infants receiving positive airway pressure at caffeine discontinuation by site. Infants who discontinued caffeine within the last week of hospitalization had longer total duration of caffeine, but were discharged from the hospital at an earlier postmenstrual age. Conclusion There was substantial variability among sites in the timing of caffeine discontinuation before discharge and respiratory support at the time of caffeine discontinuation.

Letter regarding “national survey on caffeine use in neonatal units across the United Kingdom”

“…With both these surveys, inter‐ unit and inter‐ clinician variability in caffeine initiation and cessation in neonates is observed. Variability in caffeine cessation was also reported in a large neonatal cohort study in the United States 2 . All clinicians ( n = 62, 100%) in our survey report the use of either local hospital, network or national guidelines for neonatal caffeine use to prevent or treat apnoea of prematurity.…”

National survey on caffeine use in neonatal units across the United Kingdom

“…In a large survey, conducted between 2001 and 2016, the reported mean PMA to stop caffeine therapy was around 34 weeks, with substantial variation across different units ranging from 32 to 37 weeks 20 . In a study reporting the natural history of apnea and bradycardia in pre‐term infants born at 24–28 weeks, 21 the incidence of apnea/bradycardia was 13% for infants born at 28 weeks and 44% for infants born at 24 weeks at PMA of 38 weeks.…”

Caffeine Therapy in Apnea of Prematurity: Traditional Review

“…Kafein kesilme zamanının 32-37 PMY arasında değiştiği, ancak yoğunluğun postmenstrüel 33-34 haftada olduğu bildirilmektedir. 25 Yakın tarihli bir derlemede de aşırı prematüre bebeklerde kafeinin postmenstrüel 34 haftaya kadar kullanılabileceği, ancak daha immatür ve BPD'li olan bebeklerde sürenin 2-3 hafta kadar uzatılabileceği, kafein tedavisi kesildikten sonra ise 5-7 gün daha bu bebeklerin apne/bradikardi bakımından monitörize edilmesi gerektiği rapor edilmektedir. 26 Gebelik haftası 26-32 arasında olan, standart kafein tedavisi (yükleme 20 mg/kg, idame 5 mg/kg/gün) uygulanan ve apnesiz 7 gün sonra kafeini kesilen bir grup ile (n=60) 34 GH'ye kadar kafein alıp apnesiz 7 gün sonra kafeini kesilen diğer grubun (n=60) karşılaştırıldığı Hindistan'dan bildirilen randomize kontrollü bir çalışmada; 2 grup arasında apne tekrarı ve yan etki bakımından bir farklılık yokken, 7 gün apnesiz dönem sonrası kafein kesilenlerde beklenildiği üzere kafein kullanım süresi ve kesilme zamanı daha kısa olarak saptanmıştır.…”