Caffeine use in preterm neonates: national insights into Turkish NICU practices

Abstract

Objective: Caffeine is a proven medication used for the prevention and treatment of apnea in premature infants, offering both short- and long-term benefits. International guidelines provide a range of recommendations regarding the preterm population eligible for caffeine prophylaxis, including the timing, dosage, and duration of treatment. Our national guidelines, published prior to the most recent updates of the international guidelines, recommend the use of caffeine citrate starting from the first day after delivery for preterm infants with a gestational age of <28 weeks. For infants up to 32 weeks, if positive pressure ventilation is required, the decision should be made on an individual basis. This study aims to describe the variability in caffeine usage across neonatal intensive care units in our country.

Methods: An online survey was sent to neonatologist who are members of the Turkish Neonatology Society to describe the variability in caffeine usage in neonatal intensive care units in our country.

Results: We collected responses from 74 units. Prophylactic caffeine usage was observed as; GA ≤27^6/7: 98.6%, GA 28^0/7-28^6/7: 89.0%, GA 29^0/7-29^6/7: 75.3%, GA 30^0/7-31^6/7: 53.4%. 62.2% of units reported administering loading dose within the first two hours. The initial maintenance dose was 5 mg/kg in 64.8% of units, 10 mg/kg in 32.4% of units, and intermediate dose in 5.3% of units. 47.3% of units reported no routine dose adjustment. The postmenstrual age that caffeine treatment was stopped was found to be 34 (min-max; 32-36) weeks for infants without apnea and respiratory support, 36 (min-max; 34-52) weeks for infants without apnea but any respiratory support. The time to discharge after treatment cessation was found as; 1-4 days: 37.8%, 5-7 days: 68.9%. Among the 56 units with multiple responsible physicians, 32.1% reported intra-unit variations.

Conclusion: The significant differences in caffeine usage characteristics between and within units highlight the need for clear recommendations provided by standardized guidelines.

Keywords: apnea of prematurity; caffeine; guideline; neonatal intensive care unit; premature neonate.

Figure 1

Bar graphic demonstrating the differences in the caffeine treatment protocol among physicians in 56 units with more than one neonatology specialist with decision-making authority.

Figure 2

The variability in caffeine practices by gestational age and respiratory support. The variance value for each gestational age group was found as follows; GA < 27^6/7: 0.163, GA = 28^0–6/7: 1.047, GA = 29^0–6/7: 1.348, GA = 30^0/7–31^6/7: 2.091, GA = 32^0/7–33^6/7: 2.097, GA = 34^0/7–36^6/7: 0.828, GA > 37^0/7: 0.101.

Figure 3

Intersection analysis of time intervals for initiation of caffeine therapy and discharge time. The bar plot quantifies the size of intersections, indicating the number of data points shared between specific combinations of intervals. The intersection matrix at the bottom visually maps these combinations, with vertical lines connecting dots to represent overlapping intervals. On the left, horizontal bars summarize the total count of data points for each individual time interval, offering a clear overview of category sizes. This comprehensive visualization highlights the dominant time intervals and their overlap in caffeine therapy application. I: Initiation, D: Discharge.