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. 2000;2001(2):CD000048.
doi: 10.1002/14651858.CD000048.

Postoperative caffeine for preventing apnea in preterm infants

D J Henderson-Smart  1 , P Steer
Affiliations

Postoperative caffeine for preventing apnea in preterm infants

D J Henderson-Smart et al. Cochrane Database Syst Rev. 2000.

Update in

Abstract

Background: Growing ex-preterm infants who undergo general anesthesia for surgery at about term-equivalent age may have episodes of apnea, cyanosis and bradycardia during the early postoperative period. Caffeine treatment given at the time of operation might prevent these episodes.

Objectives: In ex-preterm infants who undergo general anesthesia for surgery, does the prophylactic use of caffeine prevent episodes of apnea, cyanosis and bradycardia during the postoperative period without clinically important side effects?

Search strategy: The standard strategy of the Neonatal Review Group was used. This included searches of the Oxford Database of Perinatal trials, Medline, previous reviews including cross references, abstracts, conferences and symposia proceedings, expert informants and journal handsearching mainly in the English language.

Selection criteria: All trials utilising random or quasi-random patient allocation, in which treatment was compared with placebo or no treatment, were included.

Data collection and analysis: The standard methods of the Cochrane Collaboration and its Neonatal Review Group were used to select trials, evaluate quality and to extract data. The methodological quality of each trial was reviewed by the second author blinded to trial authors and institution(s). Each author extracted data separately, compared and resolved differences. Meta-analysis used relative risk and risk difference.

Main results: In each trial apnea/bradycardia occurred in fewer treated than control infants. In two trials (Welborn 1989, LeBard 1989) continuous recordings of oxygen saturation detected hypoxaemic episodes (<90 %) in fewer treatment than control infants. No infant in any trial required intubation and mechanical ventilation. No adverse effects were reported.

Reviewer's conclusions: Implications for practice. Caffeine can be used to prevent postoperative apnea/bradycardia and episodes of oxygen desaturation in growing preterm infants if this is deemed clinically necessary. In view of the small numbers of infants studied in these trials and uncertainty concerning the clinical significance of the episodes, caution is warranted in applying these results to routine clinical practice. Implications for research. There is a need to determine which infants might benefit most by this treatment. Studies confined to those most at risk of apnea (prior history, younger postmenstrual age) and those that might require mechanical ventilation (chronic lung disease) would be of value.

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Conflict of interest statement

None

Figures

1.1
1.1. Analysis
Comparison 1 Caffeine vs placebo with induction of general anesthesia, Outcome 1 Postoperative apnoea/bradycardia.
1.2
1.2. Analysis
Comparison 1 Caffeine vs placebo with induction of general anesthesia, Outcome 2 Postoperative oxygen desaturations.
See this image and copyright information in PMC

References

References to studies included in this review

LeBard 1989 {published data only}
    1. LeBard SE, Kurth CD, Spitzer AR, Downes JJ. Preventing postoperative apnea by neuromodulator antagonists. Anesthesiology 1989;71:A1026.
Welborn 1988 {published data only}
    1. Welborn LG, Soto H, Hannallah RS, Fink R, Ruttimann UE, Boeckx R. The use of caffeine in the control of post‐anesthetic apnea in former premature infants. Anesthesiology 1988;68:796‐8. - PubMed
Welborn 1989 {published data only}
    1. Welborn LG, Hannallah RS, Fink R, Ruttimann UE, Hicks JM. High‐dose caffeine suppresses postoperative apnea in former preterm infants. Anesthesiology 1989;71:347‐9. - PubMed

Additional references

AAP 2003
    1. American Academy of Pediatrics. Policy statement. Apnea, Sudden Infant Death Syndrome, and home monitoring. Pediatrics 2003;111:914‐17. - PubMed
Cote 1995
    1. Cote CJ, Zaslavsky A, Downes JJ, Kurth CD, Welborn LG, Warner LO, Malviya SV. Postoperative apnea in former preterm infants after inguinal herniorrhaphy. Anesthesiology 1995;82:809‐22. - PubMed
Craven 2003
    1. Craven PD, Badawi N, Henderson‐Smart DJ, O'Brien M. Regional (spinal, epidural, caudal) versus general anaesthesia in preterm infants undergoing inguinal herniorrhaphy in early infancy. Cochrane Database of Systematic Reviews 2003, Issue 4. [DOI: 10.1002/14651858.CD003669] - DOI - PubMed
Henderson‐Smart a
    1. Henderson‐Smart DJ, Steer P. Methylxanthine treatment for apnoea in preterm infants. Cochrane Database of Systematic Reviews 2010, Issue 12. [DOI: 10.1002/14651858.CD000140] - DOI - PMC - PubMed
Henderson‐Smart b
    1. Henderson‐Smart DJ, Davis PG. Prophylactic methylxanthine for extubation in preterm infants. Cochrane Database of Systematic Reviews 2010, Issue 12. [DOI: 10.1002/14651858.CD000139] - DOI - PubMed
Henderson‐Smart c
    1. Henderson‐Smart DJ, Steer PA. Prophylactic methylxanthine for preventing of apnoea in preterm infants. Cochrane Database of Systematic Reviews 2010, Issue 12. [DOI: 10.1002/14651858.CD000432] - DOI - PubMed
Henderson‐Smart d
    1. Henderson‐Smart DJ, Steer PA. Caffeine versus theophylline for apnoea in preterm infants. Cochrane Database of Systematic Reviews 2010, Issue 1. [DOI: 10.1002/14651858.CD000273] - DOI - PMC - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Krane 1995
    1. Krane EJ, Haberkern CM, Jacobson LE. Postoperative apnea, bradycardia, and oxygen desaturation in formerly preterm infants: prospective comparison of spinal and general anesthesia. Anesthesia and Analgesia 1995;80:7‐13. - PubMed
Liu 1983
    1. Liu LM, Cote CJ, Goudsouzian NG, Ryan JF, Firestone S, Dedrick DF, Liu PL, Todres ID. Life‐threatening apnea in infants recovering from anesthesia. Anesthesiology 1983;59:506‐10. - PubMed
Sale 2006
    1. Sale SM, Read JA, Stoddart PA, Wolf AR. Prospective comparison of sevoflurane and desflurane in formerly premature infants undergoing inguinal herniotomy. British Journal of Anaesthesia 2006;96:774–778. - PubMed
Spear 1992
    1. Spear RM. Anesthesia for premature and term infants: perioperative complications. Journal of Pediatrics 1992;120:165‐76. - PubMed
Welborn 1990
    1. Welborn LG, Rice LJ, Hannallah RS, Broadman LM, Ruttimann UE, Fink R. Postoperative apnea in former preterm infants: prospective comparison of spinal and general anesthesia. Anesthesiology 1990;72:838‐42. - PubMed
Welborn 1994
    1. Welborn LG, Greenspun JC. Anesthesia and apnea. Perioperative considerations in the former preterm infant. Pediatr Clin North Amer 1994;41:181‐98. - PubMed

References to other published versions of this review

Henderson‐Smart 2001
    1. Henderson‐Smart DJ, Steer PA. Prophylactic caffeine to prevent postoperative apnea in preterm infants. Cochrane Database of Systematic Reviews 2001, Issue 2. [DOI: 10.1002/14651858.CD000048] - DOI - PubMed
Henderson‐Smart 2004
    1. Henderson‐Smart DJ, Steer PA. Prophylactic caffeine to prevent postoperative apnea in preterm infants. Cochrane Database of Systematic Reviews 2004, Issue 4. [DOI: 10.1002/14651858.CD000048] - DOI - PubMed

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