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Meta-Analysis
. 2017 Jan;83(1):180-191.
doi: 10.1111/bcp.13089. Epub 2016 Sep 30.

Systematic review and meta-analysis of clinical outcomes of early caffeine therapy in preterm neonates

Kok Pim Kua  1 , Shaun Wen Huey Lee  1
Affiliations
Meta-Analysis

Systematic review and meta-analysis of clinical outcomes of early caffeine therapy in preterm neonates

Kok Pim Kua et al. Br J Clin Pharmacol. 2017 Jan.

Erratum in

  • Correction.
    [No authors listed] [No authors listed] Br J Clin Pharmacol. 2021 Mar;87(3):1630. doi: 10.1111/bcp.14602. Br J Clin Pharmacol. 2021. PMID: 33657771 No abstract available.

Abstract

Aims: This study evaluated the therapeutic outcomes of early versus late caffeine therapy in preterm neonates.

Methods: We performed a systematic literature search in PubMed, Embase, CINAHL and CENTRAL from inception to 30 June 2016 to identify studies investigating the use of early caffeine therapy (initiated at less than 3 days of life) in preterm infants. Effect estimates were combined using random-effects meta-analysis. The primary outcomes for this study were bronchopulmonary dysplasia and mortality.

Results: The initial search found 4066 citations, of which 14 studies enrolling a total of 64 438 participants were included. The time of initiation of early caffeine therapy varied from the first 2 h to 3 days postnatal. Early caffeine therapy reduced the risk of bronchopulmonary dysplasia in both cohort studies (RR: 0.80, 95% CI: 0.66 to 0.96) and randomized controlled trials (RR: 0.67, 95% CI: 0.56 to 0.81). In cohort studies, neonates treated early with caffeine also showed decreased risks of patent ductus arteriosus, brain injury, retinopathy of prematurity and postnatal steroid use. However, the mortality rate was increased.

Conclusions: The findings suggest that early caffeine therapy is associated with reduced incidence of bronchopulmonary dysplasia and may help decrease the burden of morbidities in preterm infants.

Keywords: intensive care; meta-analysis; neonatology; pharmacotherapy; systematic review.

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Figures

Figure 1
Figure 1
Preferred reporting items for systematic reviews and meta‐analyses (PRISMA) flow diagram
Figure 2
Figure 2
Outcomes of retrospective cohort studies and randomized controlled trials evaluating early (initiation <3 days of life) vs. late caffeine therapy (initiation ≥3 days of life) [5 cohort studies vs. 2 RCTs]
Figure 3
Figure 3
Forest plot of duration of mechanical ventilation in retrospective cohort studies evaluating early (initiation <3 days of life) vs. late caffeine therapy (initiation ≥3 days of life)
Figure 4
Figure 4
Forest plot of duration of therapy with caffeine in retrospective cohort studies evaluating early (initiation <3 days of life) vs. late caffeine therapy (initiation ≥3 days of life)
Figure 5
Figure 5
Outcomes of randomized controlled trials evaluating early caffeine therapy (initiation <3 days of life) vs. placebo
See this image and copyright information in PMC

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