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Observational Study
. 2017 Nov:190:108-111.e1.
doi: 10.1016/j.jpeds.2017.07.006. Epub 2017 Sep 7.

Early Caffeine Prophylaxis and Risk of Failure of Initial Continuous Positive Airway Pressure in Very Low Birth Weight Infants

Ravi M Patel  1 , Kanecia Zimmerman  2 , David P Carlton  3 , Reese Clark  4 , Daniel K Benjamin  5 , P Brian Smith  2
Affiliations
Observational Study

Early Caffeine Prophylaxis and Risk of Failure of Initial Continuous Positive Airway Pressure in Very Low Birth Weight Infants

Ravi M Patel et al. J Pediatr. 2017 Nov.

Abstract

Objective: To test the hypothesis that early caffeine treatment on the day of birth, compared with later treatment in very low birth weight (VLBW, <1500 g) infants receiving continuous positive airway pressure (CPAP) therapy, is associated with a decreased risk of CPAP failure in the first week of life.

Study design: Multicenter, observational cohort study in 366 US neonatal intensive care units. We evaluated inborn, VLBW infants discharged from 2000 to 2014, who received only CPAP therapy without surfactant treatment on day of life (DOL) 0, had a 5-minute Apgar ≥3, and received caffeine in the first week of life. We used multivariable conditional logistic regression to compare the risk of CPAP failure, defined as invasive mechanical ventilation or surfactant therapy on DOL 1-6, by timing of caffeine treatment as either early (initiation on DOL 0) or routine (initiation on DOL 1-6).

Results: We identified 11 133 infants; 4528 (41%) received early caffeine and 6605 (59%) received routine caffeine. Median gestational age was lower in the early caffeine group, 29 weeks (25th, 75th percentiles; 28, 30) vs the routine caffeine group, 30 weeks (29, 31); P < 0.001. The incidence of CPAP failure on DOL 1-6 was similar between the early and routine caffeine groups: 22% vs 21%; adjusted OR = 1.05 (95% CI: 0.93, 1.18).

Conclusions: Early caffeine treatment on the day of birth was not associated with a decreased risk of CPAP failure in the first week of life for VLBW infants initially treated with CPAP.

Keywords: apnea; extremely preterm; methylxanthine; pulmonary outcomes.

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Conflict of interest statement

The other authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flow diagram of subject selection and outcome evaluation.
Figure 2
Figure 2
Receipt of early caffeine prophylaxis by year among study infants.
See this image and copyright information in PMC

Comment in

  • Caffeine therapy-when and why?
    Jobe AH. Jobe AH. J Pediatr. 2017 Nov;190:2. doi: 10.1016/j.jpeds.2017.09.032. J Pediatr. 2017. PMID: 29144246 No abstract available.

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