Effect of different maintenance doses of caffeine citrate on ventilator weaning in very preterm infants with respiratory distress syndrome: a prospective randomized controlled trial
LI Xiao-Lan, CAI Yue-Ju, ZHANG Zhe, LI Jian, CHEN Xiao-Wen, SONG Yan-Yan, ZHOU Wei
Department of Child Health Care, Guangzhou Women and Children's Medical Center, Guangzhou 510623, China
Abstract：Objective To study the effect of different maintenance doses of caffeine citrate on the success rate of ventilator weaning in very preterm infants (gestational age of ≤32 weeks) with respiratory distress syndrome (RDS). Methods A total of 162 preterm infants with RDS who were admitted to the hospital from January 2016 to December 2018 were enrolled in this prospective trial. These infants had a gestational age of ≤32 weeks and required invasive mechanical ventilation. They were randomly divided into a high-dose caffeine group and a low-dose caffeine group, with 81 infants in each group. Within 6 hours after birth, both groups were given caffeine at a dose of 20 mg/kg. After 24 hours, the high- and low-dose caffeine groups were given caffeine at a maintenance dose of 10 mg/kg and 5 mg/kg, respectively. The two groups were compared in terms of re-intubation rate within 48 hours after ventilator weaning, durations of ventilation and oxygen therapy, enteral feeding, weight gain, and the incidence rates of complications and adverse reactions during hospitalization. Results The high-dose caffeine group had a significantly lower re-intubation rate within 48 hours after ventilator weaning than the low-dose caffeine group (P<0.05), with frequent apnea as the main reason for failed ventilator weaning in both groups. The high-dose caffeine group had significantly shorter durations of mechanical ventilation and oxygen therapy than the low-dose caffeine group (P<0.05). There were no significant differences between the two groups in the time to total enteral feeding, average daily weight gain, body weight at discharge, and the incidence rates of complications (bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, and intracranial hemorrhage) and adverse reactions (tachycardia, hypertension, and feeding intolerance) (P>0.05). Conclusions A high maintenance dose of caffeine can safely and effectively reduce the incidence rate of apnea after ventilator weaning and the failure rate of ventilator weaning in RDS preterm infants with a gestational age of ≤32 weeks, and therefore, it holds promise for clinical application.
LI Xiao-Lan,CAI Yue-Ju,ZHANG Zhe et al. Effect of different maintenance doses of caffeine citrate on ventilator weaning in very preterm infants with respiratory distress syndrome: a prospective randomized controlled trial[J]. CJCP, 2021, 23(11): 1097-1102.
Choi YB, Lee J, Park J, et al. Impact of prolonged mechanical ventilation in very low birth weight infants: results from a national cohort study[J]. J Pediatr, 2018, 194: 34-39.e3. PMID: 29198532. DOI: 10.1016/j.jpeds.2017.10.042.
Mohammed S, Nour I, Shabaan AE, et al. High versus low-dose caffeine for apnea of prematurity: a randomized controlled trial[J]. Eur J Pediatr, 2015, 174(7): 949-956. PMID: 25644724. DOI: 10.1007/s00431-015-2494-8.
Escobar V, Soares DS, Kreling J, et al. Influence of time under mechanical ventilation on bronchopulmonary dysplasia severity in extremely preterm infants: a pilot study[J]. BMC Pediatr, 2020, 20(1): 241. PMID: 32438923. PMCID: PMC7240994. DOI: 10.1186/s12887-020-02129-2.
Shalish W, Kanbar L, Kovacs L, et al. The impact of time interval between extubation and reintubation on death or bronchopulmonary dysplasia in extremely preterm infants[J]. J Pediatr, 2019, 205: 70-76.e2. PMID: 30404739. DOI: 10.1016/j.jpeds.2018.09.062.
Shalish W, Kanbar L, Keszler M, et al. Patterns of reintubation in extremely preterm infants: a longitudinal cohort study[J]. Pediatr Res, 2018, 83(5): 969-975. PMID: 29389921. DOI: 10.1038/pr.2017.330.
Lodha A, Entz R, Synnes A, et al. Early caffeine administration and neurodevelopmental outcomes in preterm infants[J]. Pediatrics, 2019, 143(1): e20181348. PMID: 30518670. DOI: 10.1542/peds.2018-1348.
Razak A, Faden M. Association of small for gestational age with retinopathy of prematurity: a systematic review and meta-analysis[J]. Arch Dis Child Fetal Neonatal Ed, 2020, 105(3): 270-278. PMID: 31326921. DOI: 10.1136/archdischild-2019-316976.
Chen J, Jin L, Chen X. Efficacy and safety of different maintenance doses of caffeine citrate for treatment of apnea in premature infants: a systematic review and meta-analysis[J]. Biomed Res Int, 2018, 2018: 9061234. PMID: 30671477. PMCID: PMC6323495. DOI: 10.1155/2018/9061234.
