不同维持剂量枸橼酸咖啡因对极早产儿呼吸窘迫综合征撤机影响：前瞻性随机对照研究

doi:10.7499/j.issn.1008-8830.2107167

Abstract
Figure/Table
References(25)
Related Citation (15)
Read Tracking
Download Tracking

Download: PDF (595 KB) HTML
Export: BibTeX | EndNote (RIS) Supporting Info

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.

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	LI Xiao-Lan
	CAI Yue-Ju
	ZHANG Zhe
	LI Jian
	CHEN Xiao-Wen
	SONG Yan-Yan
	ZHOU Wei

Key words： Respiratory distress syndrome Caffeine citrate Ventilator weaning Preterm infant

Received: 30 July 2021

Cite this article:

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.

URL:

http://www.zgddek.com/EN/10.7499/j.issn.1008-8830.2107167 OR http://www.zgddek.com/EN/Y2021/V23/I11/1097

	1 徐凤丹, 段顺艳, 孔祥永, 等. 中国13家医院住院分娩早产儿呼吸窘迫综合征前瞻性调查分析[J]. 发育医学电子杂志, 2016, 4(2): 106-118.
	2 茹喜芳, 冯琪. 新生儿呼吸窘迫综合征的防治——欧洲共识指南2019版[J]. 中华新生儿科杂志, 2019, 34(3): 239-240. DOI: 10.3760/cma.j.issn.2096-2932.2019.03.020.
	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.
	杨洋, 程锐, 吴琦, 等. 不同起始时间应用咖啡因对早产儿安全性及有效性的评估: 一项江苏省多中心研究[J]. 中国当代儿科杂志, 2020, 22(2): 130-135. PMID: 32051079. PMCID: PMC7390015. DOI: 10.7499/j.issn.1008-8830.2020.02.009.
	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.
	姚岭松, 林新祝, 黄静, 等. 撤机前加用一剂维持量咖啡因在早产儿呼吸窘迫综合征中的应用价值: 前瞻性随机对照试验[J]. 中国当代儿科杂志, 2021, 23(1): 31-36. PMID: 33476534. PMCID: PMC7818149. DOI: 10.7499/j.issn.1008-8830.2008044.
	Alhersh E, Abushanab D, Al-Shaibi S, et al. Caffeine for the treatment of apnea in the neonatal intensive care unit: a systematic overview of meta-analyses[J]. Paediatr Drugs, 2020, 22(4): 399-408. PMID: 32488731. PMCID: PMC7266675. DOI: 10.1007/s40272-020-00404-4.
	8 黄晓展, 庄方莉, 刘永兴. 不同剂量枸橼酸咖啡因对早产儿撤机近期疗效研究[J]. 实用中西医结合临床, 2020, 20(6): 43-44. DOI: 10.13638/j.issn.1671-4040.2020.06.019.
	9 邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 4版. 北京: 人民卫生出版社, 2011.
	中国医师协会新生儿科医师分会循证专业委员会. 早产儿喂养不耐受临床诊疗指南(2020)[J]. 中国当代儿科杂志, 2020, 22(10): 1047-1055. PMID: 33059799. PMCID: PMC7568993. DOI: 10.7499/j.issn.1008-8830.2008132.
	柯华, 李占魁, 于西萍, 等. 不同剂型布地奈德联合肺表面活性物质治疗新生儿呼吸窘迫综合征疗效的比较[J]. 中国当代儿科杂志, 2016, 18(5): 400-404. PMID: 27165587. PMCID: PMC7390364. DOI: 10.7499/j.issn.1008-8830.2016.05.005.
	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.
	江苏省新生儿重症监护病房母乳质量改进临床研究协作组. 多中心回顾性分析极低及超低出生体重儿支气管肺发育不良的临床特点及高危因素[J]. 中华儿科杂志, 2019, 57(1): 33-39. PMID: 30630229. DOI: 10.3760/cma.j.issn.0578-1310.2019.01.009.
	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.
	Chawla S, Natarajan G, Shankaran S, et al. Markers of successful extubation in extremely preterm infants, and morbidity after failed extubation[J]. J Pediatr, 2017, 189: 113-119.e2. PMID: 28600154. PMCID: PMC5657557. DOI: 10.1016/j.jpeds.2017.04.050.
	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.
	Lamba V, Winners O, Fort P. Early high-dose caffeine improves respiratory outcomes in preterm infants[J]. Children (Basel), 2021, 8(6): 501. PMID: 34199266. PMCID: PMC8231791. DOI: 10.3390/children8060501.
	Francart SJ, Allen MK, Stegall-Zanation J. Apnea of prematurity: caffeine dose optimization[J]. J Pediatr Pharmacol Ther, 2013, 18(1): 45-52. PMID: 23616735. PMCID: PMC3626066. DOI: 10.5863/1551-6776-18.1.45.
	Wan LJ, Huang L, Chen PY. Caffeine citrate maintenance doses effect on extubation and apnea postventilation in preterm infants[J]. Pediatr Pulmonol, 2020, 55(10): 2635-2640. PMID: 32639634. DOI: 10.1002/ppul.24948.
	张霄, 张海涛, 吕勇, 等. 不同维持剂量枸橼酸咖啡因治疗极低出生体重早产儿呼吸暂停的前瞻性随机对照研究[J]. 中国当代儿科杂志, 2019, 21(6): 558-561. PMID: 31208509. PMCID: PMC7389581. DOI: 10.7499/j.issn.1008-8830.2019.06.011.
	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.
	James JE. Maternal caffeine consumption and pregnancy outcomes: a narrative review with implications for advice to mothers and mothers-to-be[J]. BMJ Evid Based Med, 2021, 26(3): 114-115. PMID: 32843532. PMCID: PMC8165152. DOI: 10.1136/bmjebm-2020-111432.
	Soltani S, Salari-Moghaddam A, Saneei P, et al. Maternal caffeine consumption during pregnancy and risk of low birth weight: a dose-response meta-analysis of cohort studies[J]. Crit Rev Food Sci Nutr, 2021. PMID: 34224282. DOI: 10.1080/10408398.2021.1945532. Epub ahead of print.