High dose caffeine citrate for extubation of preterm infants: a randomised controlled trial.
Journal: 2004/November - Archives of Disease in Childhood: Fetal and Neonatal Edition
ISSN: 1359-2998
Abstract:
OBJECTIVE
To compare two dosing regimens for caffeine citrate in the periextubation period for neonates born at less than 30 weeks gestation in terms of successful extubation and adverse effects.
METHODS
A multicentre, randomised, double blind, clinical trial.
METHODS
Four tertiary neonatal units within Australia.
METHODS
Infants born less than 30 weeks gestation ventilated for more than 48 hours.
METHODS
Two dosing regimens of caffeine citrate (20 v 5 mg/kg/day) for periextubation management. Treatment started 24 hours before a planned extubation or within six hours of an unplanned extubation.
METHODS
Failure to extubate within 48 hours of caffeine loading or reintubation and ventilation or doxapram within seven days of caffeine loading.
RESULTS
A total of 234 neonates were enrolled. A significant reduction in failure to extubate was shown for the 20 mg/kg/day dosing group (15.0% v 29.8%; relative risk 0.51; 95% confidence interval (CI) 0.31 to 0.85; number needed to treat 7 (95% CI 4 to 24)). A significant difference in duration of mechanical ventilation was shown for infants of less than 28 weeks gestation receiving the high dose of caffeine (mean (SD) days 14.4 (11.1) v 22.1 (17.1); p = 0.01). No difference in adverse effects was detected in terms of mortality, major neonatal morbidity, death, or severe disability or general quotient at 12 months.
CONCLUSIONS
This trial shows short term benefits for a 20 mg/kg/day dosing regimen of caffeine citrate for neonates born at less than 30 weeks gestation in the periextubation period, without evidence of harm in the first year of life.
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Arch Dis Child Fetal Neonatal Ed 89(6): F499-F503

High dose caffeine citrate for extubation of preterm infants: a randomised controlled trial

+7 authors

Abstract

Objective: To compare two dosing regimens for caffeine citrate in the periextubation period for neonates born at less than 30 weeks gestation in terms of successful extubation and adverse effects.

Design: A multicentre, randomised, double blind, clinical trial.

Setting: Four tertiary neonatal units within Australia.

Patients: Infants born less than 30 weeks gestation ventilated for more than 48 hours.

Interventions: Two dosing regimens of caffeine citrate (20 v 5 mg/kg/day) for periextubation management. Treatment started 24 hours before a planned extubation or within six hours of an unplanned extubation.

Main outcome measure: Failure to extubate within 48 hours of caffeine loading or reintubation and ventilation or doxapram within seven days of caffeine loading.

Results: A total of 234 neonates were enrolled. A significant reduction in failure to extubate was shown for the 20 mg/kg/day dosing group (15.0% v 29.8%; relative risk 0.51; 95% confidence interval (CI) 0.31 to 0.85; number needed to treat 7 (95% CI 4 to 24)). A significant difference in duration of mechanical ventilation was shown for infants of less than 28 weeks gestation receiving the high dose of caffeine (mean (SD) days 14.4 (11.1) v 22.1 (17.1); p = 0.01). No difference in adverse effects was detected in terms of mortality, major neonatal morbidity, death, or severe disability or general quotient at 12 months.

Conclusions: This trial shows short term benefits for a 20 mg/kg/day dosing regimen of caffeine citrate for neonates born at less than 30 weeks gestation in the periextubation period, without evidence of harm in the first year of life.

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Selected References

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  • Crowley P, Chalmers I, Keirse MJ. The effects of corticosteroid administration before preterm delivery: an overview of the evidence from controlled trials. Br J Obstet Gynaecol. 1990 Jan;97(1):11–25. [PubMed] [Google Scholar]
  • Martin RJ, Walsh-Sukys MC. Bronchopulmonary dysplasia--no simple solution. N Engl J Med. 1999 Apr 1;340(13):1036–1038. [PubMed] [Google Scholar]
  • Aranda JV, Turmen T. Methylxanthines in apnea of prematurity. Clin Perinatol. 1979 Mar;6(1):87–108. [PubMed] [Google Scholar]
  • Laubscher B, Greenough A, Dimitriou G. Comparative effects of theophylline and caffeine on respiratory function of prematurely born infants. Early Hum Dev. 1998 Jan 9;50(2):185–192. [PubMed] [Google Scholar]
  • Larsen PB, Brendstrup L, Skov L, Flachs H. Aminophylline versus caffeine citrate for apnea and bradycardia prophylaxis in premature neonates. Acta Paediatr. 1995 Apr;84(4):360–364. [PubMed] [Google Scholar]
  • Comer AM, Perry CM, Figgitt DP. Caffeine citrate: a review of its use in apnoea of prematurity. Paediatr Drugs. 2001;3(1):61–79. [PubMed] [Google Scholar]
  • Aranda JV, Cook CE, Gorman W, Collinge JM, Loughnan PM, Outerbridge EW, Aldridge A, Neims AH. Pharmacokinetic profile of caffeine in the premature newborn infant with apnea. J Pediatr. 1979 Apr;94(4):663–668. [PubMed] [Google Scholar]
  • Scanlon JE, Chin KC, Morgan ME, Durbin GM, Hale KA, Brown SS. Caffeine or theophylline for neonatal apnoea? Arch Dis Child. 1992 Apr;67(4 Spec No):425–428.[PMC free article] [PubMed] [Google Scholar]
  • Steer PA, Flenady VJ, Shearman A, Lee TC, Tudehope DI, Charles BG. Periextubation caffeine in preterm neonates: a randomized dose response trial. J Paediatr Child Health. 2003 Sep-Oct;39(7):511–515. [PubMed] [Google Scholar]
  • Lee TC, Charles B, Steer P, Flenady V, Shearman A. Population pharmacokinetics of intravenous caffeine in neonates with apnea of prematurity. Clin Pharmacol Ther. 1997 Jun;61(6):628–640. [PubMed] [Google Scholar]
  • Sims ME, Rangasamy R, Lee S, Chung H, Cohen J, Walther FJ. Comparative evaluation of caffeine and theophylline for weaning premature infants from the ventilator. Am J Perinatol. 1989 Jan;6(1):72–75. [PubMed] [Google Scholar]
  • Muttitt SC, Finer NN, Tierney AJ, Rossmann J. Neonatal apnea: diagnosis by nurse versus computer. Pediatrics. 1988 Nov;82(5):713–720. [PubMed] [Google Scholar]
  • Bauer J, Maier K, Linderkamp O, Hentschel R. Effect of caffeine on oxygen consumption and metabolic rate in very low birth weight infants with idiopathic apnea. Pediatrics. 2001 Apr;107(4):660–663. [PubMed] [Google Scholar]
  • Schmidt B. Methylxanthine therapy in premature infants: sound practice, disaster, or fruitless byway? J Pediatr. 1999 Oct;135(4):526–528. [PubMed] [Google Scholar]
  • Davis PG, Doyle LW, Rickards AL, Kelly EA, Ford GW, Davis NM, Callanan C. Methylxanthines and sensorineural outcome at 14 years in children < 1501 g birthweight. J Paediatr Child Health. 2000 Feb;36(1):47–50. [PubMed] [Google Scholar]
  • Schmidt B, Davis P, Moddemann D, Ohlsson A, Roberts RS, Saigal S, Solimano A, Vincer M, Wright LL. Long-term effects of indomethacin prophylaxis in extremely-low-birth-weight infants. N Engl J Med. 2001 Jun 28;344(26):1966–1972. [PubMed] [Google Scholar]

Abstract

Objective: To compare two dosing regimens for caffeine citrate in the periextubation period for neonates born at less than 30 weeks gestation in terms of successful extubation and adverse effects.

Design: A multicentre, randomised, double blind, clinical trial.

Setting: Four tertiary neonatal units within Australia.

Patients: Infants born less than 30 weeks gestation ventilated for more than 48 hours.

Interventions: Two dosing regimens of caffeine citrate (20 v 5 mg/kg/day) for periextubation management. Treatment started 24 hours before a planned extubation or within six hours of an unplanned extubation.

Main outcome measure: Failure to extubate within 48 hours of caffeine loading or reintubation and ventilation or doxapram within seven days of caffeine loading.

Results: A total of 234 neonates were enrolled. A significant reduction in failure to extubate was shown for the 20 mg/kg/day dosing group (15.0% v 29.8%; relative risk 0.51; 95% confidence interval (CI) 0.31 to 0.85; number needed to treat 7 (95% CI 4 to 24)). A significant difference in duration of mechanical ventilation was shown for infants of less than 28 weeks gestation receiving the high dose of caffeine (mean (SD) days 14.4 (11.1) v 22.1 (17.1); p = 0.01). No difference in adverse effects was detected in terms of mortality, major neonatal morbidity, death, or severe disability or general quotient at 12 months.

Conclusions: This trial shows short term benefits for a 20 mg/kg/day dosing regimen of caffeine citrate for neonates born at less than 30 weeks gestation in the periextubation period, without evidence of harm in the first year of life.

Abstract
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