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. 2025 Sep;60(9):e71312.
doi: 10.1002/ppul.71312.

Caffeine for Persistent Intermittent Hypoxia in Newborns With and Without Chronic Lung Disease

Aurore Côté  1 , Phoukim Savanh  2 , Wissam Shalish  3 , Victoria Bizgu  2 , Anne-Marie Canakis  4
Affiliations

Caffeine for Persistent Intermittent Hypoxia in Newborns With and Without Chronic Lung Disease

Aurore Côté et al. Pediatr Pulmonol. 2025 Sep.

Abstract

Objectives: To assess the caffeine response in preterm and term newborns with persistent intermittent hypoxia (IH) as they approach discharge, with particular focus on newborns with chronic lung disease of prematurity (CLD). To identify factors associated with a lack of response to caffeine.

Design/settings: Retrospective cohort study across two neonatal intensive care units between 2015 and 2022.

Main outcomes following caffeine administration: Normal oximetry; no need for respiratory support; resolution of hypercapnia.

Results: A total of 132 infants received caffeine for persistent IH. Normal oximetry was achieved post-caffeine in 81% (46/57) of newborns with CLD, in 96% (46/48) of preterm with no CLD, in 96% (26/27) of term newborns. Caffeine reduced the % time with SpO2 < 90% from 6.8% (interquartile range, 3.8%-12.2%), to 0.8% (0.4%-1.6%, p < 0.0001). The desaturation index < 80% dropped from 5.3 events/hour (0.9-14.6 events/hour) to 0.2 events/hour (0-0.78 events/hour, p < 0.0001) and the desaturation index ≥ 10% lasting > 10 s went from 6.6 events/hour (3.3-10.7 events/hour) to 1.4 events/hour (0.7-2.4 events/hour, p < 0.0001). Of the 61 infants on respiratory support, 74% (45/61) were weaned within a few days following caffeine. Caffeine normalized PCO2 in 63% (41/65) of newborns with elevated PCO2 pre-caffeine. Infants failing caffeine were more likely to have CLD compared to responders (79% vs. 39%, p < 0.005). Caffeine was successfully discontinued (first attempt, normal oximetry) in 101 infants (88%) at postmenstrual age of 46.1 weeks (45.3-48.3 weeks).

Conclusion: Caffeine improved respiratory outcomes in the majority of preterm and term born infants with persistent IH, including those with CLD.

Keywords: hypercapnia; oximetry; ventilator support.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flow diagram from initiation of caffeine to follow‐up results after cessation of caffeine. [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 2
FIGURE 2
(A) Oximetry tracing of a prematurely born infant (27 5/7 weeks) started on caffeine at 40 weeks postmenstrual age. Note the marked improvement post‐caffeine (3 days after start of treatment). (B) Oximetry tracing of a prematurely born infant with CLD (26 1/7 weeks) started on caffeine at 39 weeks postmenstrual age. Note the partial improvement post caffeine (4 days after start of treatment).
See this image and copyright information in PMC

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