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- Title
Association of Caffeine Daily Dose With Respiratory Outcomes in Preterm Neonates: A Retrospective Cohort Study.
- Authors
Rauf, Shahzad; Shah, Samar; Bibi, Zainab; Munir, Rabiya; Jiskani, Hamna; Ahmad, Saeed; Mir Shah, Syed Adil; Bibi, Aysha; Fasih Ahmad, Hafiz; Hussain, Kashif; Ariff, Shabina; Ambreen, Gul
- Abstract
Apnea and poor respiratory drive increase the risk of extubation failure (EF) and prolonged invasive mechanical ventilation (IMV) in preterm neonates (pre-nates) with respiratory distress. Caffeine citrate (CC) is often prescribed for pre-nates in doses of 5–10 mg/kg in 24 h. This study aimed to evaluate the most effective dosage regimen (5 mg/kg/day vs >5-10 mg/kg/day) to prevent apnea and EF with minimal caffeine-associated potential side effects (CC-APSEs) in pre-nates. This one-year retrospective cohort study included all the eligible neonates admitted to NICU and received CC-therapy till 28 days of life (DOL) or discharge. Based on CC-daily dose formed LD-caffeine-group (5 mg/kg/day) and HD-caffeine-group (>5-10 mg/kg/day). Antenatal, prenatal, and postnatal characteristics, CC-regimen, comorbidities, and CC-APSEs were compared between the groups. Predictors of apnea and EF were analyzed through logistic regression. There were 181 and 72 neonates in the LD and HD-caffeine-groups respectively. In HD-caffeine-group daily CC-dose was 7 to 7.5 mg/kg/day in 93% of neonates and >7.5 to 10 mg/kg/day in only 7%. Significantly fewer neonates experienced apnea and EF in the HD-caffeine-group till 28DOL or discharge. This difference was even greater in the subgroup of ≤28 weeks GA (15.6% vs 40.0%; P <.01). In HD-caffeine-group the incidence of severe/moderate-BPD was significantly lower and the frequency of CC-APSEs was higher. Multivariate analysis showed that; the smaller the GA higher the risk of apnea (AOR = 0.510, 95% CI 0.483-0.999) and EF (AOR = 0.787, 95% CI 0.411-0.997). The HD-caffeine was inversely associated with developing apnea (AOR = 0.244, 95% CI 0.053-0.291) and EF (AOR = 0.103, 95% CI 0.098-2.976). IMV-duration before extubation (AOR = 2.229, 95% CI 1.672-2.498) and severe/moderate-BPD (AOR = 2.410, 95%CI 1.104-2.952) had a high risk of EF. Initiating early HD-caffeine may prevent apnea and extubation failure in preterm neonates. Optimization of caffeine initiation time and dosages can be a safe and feasible approach to decrease the burden of neonatal respiratory morbidities.
- Subjects
CAFFEINE; RISK assessment; MORTALITY; ACADEMIC medical centers; T-test (Statistics); NEONATAL intensive care units; APNEA of prematurity; TREATMENT effectiveness; RETROSPECTIVE studies; NEONATAL intensive care; MULTIVARIATE analysis; DESCRIPTIVE statistics; LONGITUDINAL method; INTRAVENOUS therapy; NEONATAL necrotizing enterocolitis; BRADYCARDIA; ODDS ratio; ARTIFICIAL respiration; ELECTRONIC health records; MEDICAL records; ACQUISITION of data; STATISTICS; CITRATES; EXTUBATION; TREATMENT failure; LENGTH of stay in hospitals; TACHYCARDIA; CONFIDENCE intervals; DATA analysis software; HEALTH outcome assessment; COMORBIDITY; REGRESSION analysis; EVALUATION; DISEASE risk factors; CHILDREN
- Publication
Inquiry (00469580), 2024, p1
- ISSN
0046-9580
- Publication type
Article
- DOI
10.1177/00469580241248098