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Ahmed S, Rehman AU, Bibi Z, Iftikhar S, Raza M, Yousuf HMA, Naz F, Shah SAM, Mir SL, Bibi A, Khan WA, Salat MS, Ambreen G, Hussain K. Predictors for poor daily weight gain in preterm neonates exposed to different dose regimens of caffeine in ICU- a retrospective cohort study. BMC Pediatr 2024; 24:401. [PMID: 38898410 PMCID: PMC11188204 DOI: 10.1186/s12887-024-04850-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND With a wide therapeutic index, efficacy, ease of use, and other neuroprotective and respiratory benefits, caffeine citrate(CC) is currently the drug of choice for preterm neonates (PTNs). Caffeine-induced excessive energy expenditure, diuresis, natriuresis, and other CC-associated potential side-effects (CC-APSEs) result in lower daily-weight gain (WG) in premature neonates. This study aimed to evaluate the risk factors for daily-WG in neonates exposed to different dose regimens of caffeine in ICU. METHOD This retrospective cohort study included neonates of ≤ 36weeks gestational age (GA) and received CC-therapy. The same participants were followed for data analysis in two postnatal phases: 15-28 and 29-42 days of life (DOL). Based on daily CC-dose, formed group-I (received; standard-doses = 5 mg/kg/day), group-II (received;>5-7 mg/kg/day), and group-III (received;>7 mg/kg/day). Prenatal and postnatal clinical characteristics, CC-regimen, daily-WG, CC-APSEs, and concomitant risk-factors, including daily-caloric intake, Parenteral-Nutrition duration, steroids, diuretics, and ibuprofen exposure, were analyzed separately for group-II and group-III using group-I as standard. Regression analysis was performed to evaluate the risk factors for daily-WG. RESULTS Included 314 PTNs. During 15-28 DOL, the mean-daily-WG(MD-WG) was significantly higher in group-I than group-II [19.9 ± 0.70 g/kg/d vs. 17.7 ± 0.52 p = 0.036] and group-III [19.9 ± 0.70 g/kg/d vs. 16.8 ± 0.73 p < 0.001]. During 29-42 DOL the MD-WG of group-I was only significantly higher than group-III [21.7 ± 0.44 g/kg/d vs. 18.3 ± 0.41 g/kg/d p = 0.003] and comparable with group-II. During 15-28 DOL, observed CC-APSEs was significantly higher in group-II and III but during 29-42 DOL it was only significant in group-III. In the adjusted regression analysis for daily-WG during 15-28DOL, with respect to standard-dose, 5-7 mg/kg/day (β=-1.04; 95%CI:-1.62,-0.93) and > 7-10 mg/kg/day (β=-1.36; 95%CI:-1.56,-1.02) were associated with a lower daily-WG. However, during 29-42DOL, this association was present only for > 7-10 mg/kg/day (β=-1.54; 95%CI:-1.66,-1.42). The GA ≤ 27weeks (β=-1.03 95%CI:-1.24, -0.88) was associated with lower daily-WG only during 15-28DOL. During both periods of therapy, higher cumulative-caffeine dose and presence of culture proven sepsis, tachypnea, hyponatremia, and feeding intolerance were significantly associated with lower daily-WG. Conversely, daily kcal intake was found to be linked with an increase in daily-WG in both periods. CONCLUSION In this study cohort exposure to higher caffeine daily and cumulative doses is associated with lower postnatal daily-WG in PTNs than standard-daily doses, which may be due to its catabolic effects and CC-APSEs.
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Affiliation(s)
- Saeed Ahmed
- Department of Pediatrics & Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Ayaz Ur Rehman
- Department of Pediatrics & Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Zainab Bibi
- Department of Pediatrics & Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Sundus Iftikhar
- Department of Pediatrics & Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Maleeha Raza
- Department of Pediatrics & Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Fizzah Naz
- Department of Pediatrics & Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | | | | | - Ayesha Bibi
- Dow University of Health Sciences, Karachi, Pakistan
| | - Wasif Ahmed Khan
- Department of Pediatrics & Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Sohail Salat
- Department of Pediatrics & Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Gul Ambreen
- Department of Pediatrics & Child Health, Aga Khan University Hospital, Karachi, Pakistan.
| | - Kashif Hussain
- Department of Pharmacy , Aga Khan University Hospital, Karachi, Pakistan
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Thomann J, Gaertner VD, Waldmann AD, Plastina L, Bassler D, Rüegger CM. Nasal high frequency oscillatory highflow therapy in preterm infants: A randomized crossover trial. Pediatr Pulmonol 2024; 59:323-330. [PMID: 37937894 DOI: 10.1002/ppul.26748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/05/2023] [Accepted: 10/28/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVES To assess the clinical efficacy, safety, and potential physiological mechanisms of highflow therapy with superimposed high frequency oscillations ("osciflow"). STUDY DESIGN In this prospective, randomized, single center crossover trial, 30 preterm infants were randomized to receive osciflow or highflow therapy first, each for 180 min. During osciflow, an oscillatory amplitude of 20 mbar and a frequency of 6 Hz were set. The flow rate was 4 L/min during both interventions. Primary outcome was the paired difference in the combined number of desaturations (SpO2 < 80%) and bradycardia (heart rate <80 beats per min) between interventions. Safety outcomes included nasal trauma, pneumothorax and treatment failure, and a pain score was assessed. In 20 infants, electrical impedance tomography (EIT) recordings were performed to evaluate oscillatory (VOsc ) and tidal volumes (VT ) at the lung level. RESULTS Infants with a mean (SD) postnatal age of 33.1 ± 1.2 weeks were included. The median (IQR) number of episodes of desaturation and bradycardia was 19.5 (6-49) during osciflow and 26 (6-44) during highflow therapy (paired difference -2; IQR -10 to 9; p = .37). There were no differences in safety outcomes and pain scores. During osciflow, EIT recordings showed a signal at 6 Hz, which was not detectable during highflow. Corresponding mean (SD) VOsc /VT ratio was 9% (±5%). CONCLUSIONS In preterm infants, osciflow did not reduce the number of desaturations and bradycardia compared with highflow therapy. Although VOsc were transmitted to the lung during osciflow, their magnitude was small. Osciflow was safe and well tolerated.
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Affiliation(s)
- Janine Thomann
- Department of Neonatology, Newborn Research, University Hospital and University of Zurich, Zürich, Switzerland
| | - Vincent D Gaertner
- Department of Neonatology, Newborn Research, University Hospital and University of Zurich, Zürich, Switzerland
| | - Andreas D Waldmann
- Department of Anesthesiology and Intensive Care Medicine, Rostock University Medical Center, Rostock, Germany
| | - Leonie Plastina
- Department of Neonatology, Newborn Research, University Hospital and University of Zurich, Zürich, Switzerland
| | - Dirk Bassler
- Department of Neonatology, Newborn Research, University Hospital and University of Zurich, Zürich, Switzerland
| | - Christoph M Rüegger
- Department of Neonatology, Newborn Research, University Hospital and University of Zurich, Zürich, Switzerland
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Dani C, Fusco M, Manti S, Marseglia L, Ciarcià M, Leonardi V, Corsini I, Gitto E. Effects of caffeine on diaphragmatic activity in preterm infants. Pediatr Pulmonol 2023. [PMID: 37144862 DOI: 10.1002/ppul.26439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/22/2023] [Accepted: 04/20/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Caffeine is the first-choice drug for the treatment for apnea of prematurity (AOP) in preterm infants and it has been reported that it improves the diaphragm activity. The aim of this study was to evaluate by ultrasound possible changes in diaphragm contractility and motility induced by caffeine. METHODS We studied 26 preterm infants with gestational age ≤34 weeks treated with caffeine for the prevention or treatment of AOP. Diaphragmatic ultrasound was performed 15 min (T0 ) before and 60 min (T60 ) after the loading (20 mg/kg) or maintenance (5 mg/kg) dose of caffeine. RESULTS Diaphragmatic excursion (DE) and thickness at the end of inspiration (DT-in) and expiration (DT-ex), as well as peak velocity of the excursion at the end of inspiration (DT-in) and expiration (DT-ex) increased after administration of both loading and maintenance dose of caffeine. CONCLUSIONS Ultrasounds confirmed that caffeine improves the activity of diaphragm in preterm infants improving its thickness, amplitude of excursions, and contraction velocity. These results are consistent with the effectiveness of caffeine in treating AOP and decreasing the risk of failure of noninvasive respiratory support in preterm infants with respiratory distress syndrome (RDS).
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Affiliation(s)
- Carlo Dani
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Monica Fusco
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", Neonatal and Paediatric Intensive Care Unit, University of Messina, Messina, Italy
| | - Sara Manti
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", Neonatal and Paediatric Intensive Care Unit, University of Messina, Messina, Italy
| | - Lucia Marseglia
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", Neonatal and Paediatric Intensive Care Unit, University of Messina, Messina, Italy
| | - Martina Ciarcià
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Valentina Leonardi
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Iuri Corsini
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Eloisa Gitto
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", Neonatal and Paediatric Intensive Care Unit, University of Messina, Messina, Italy
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Richmond CM, Ring F, Richmond L, Rossouw E, Ballard E, Birch P. 'Propped and prone' positioning reduces respiratory events in spontaneously breathing preterm infants: A randomised triple crossover study. J Paediatr Child Health 2023; 59:81-88. [PMID: 36314399 PMCID: PMC10092656 DOI: 10.1111/jpc.16241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 09/02/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022]
Abstract
AIM We compared effects of infant positioning and feed-rate interventions on respiratory events and oximetry parameters in spontaneously breathing preterm infants born <32 weeks gestation managed in a neonatal unit. METHODS A randomised triple crossover design was employed. n = 68 infants underwent three test conditions A: control (supine/flat, gravity bolus feeds), B: position intervention (propped/prone) and C: feed-rate intervention (continuous pump feeds) in randomised sequence over three consecutive days. Primary outcomes were number of events (apnoea, bradycardia and desaturation) and percentage time SpO2 < 80% over 24 h. The secondary outcome was percentage time SpO2 ≥ 88%. Treatment effects were estimated using linear mixed-effects models. RESULTS Propped/prone positioning significantly reduced events and improved percentage time SpO2 < 80% and ≥88% compared to both other conditions (all P < 0.001). Outcomes for the feed-rate intervention were not significantly different to control. CONCLUSIONS Alternative infant positioning should be considered in preterm infants managed in the neonatal unit.
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Affiliation(s)
- Christopher M Richmond
- Newborn Care Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia.,Genetic Health Queensland, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Fabian Ring
- Newborn Care Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Lacey Richmond
- Newborn Care Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia.,School of Nursing & Midwifery, University of Western Sydney, Penrith, New South Wales, Australia
| | - Erika Rossouw
- Newborn Care Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Emma Ballard
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,School of Nursing Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia
| | - Pita Birch
- Department of Neonatology, Mater Mother's Hospitals, South Brisbane, Queensland, Australia
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Chu YT, Chen JS, Chen YS, Yang CC, Yin CH, Wang HP, Chiou YH. Effects of early aminophylline therapy on clinical outcomes in premature infants. Pediatr Neonatol 2022; 64:288-296. [PMID: 36564309 DOI: 10.1016/j.pedneo.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 09/29/2022] [Accepted: 10/19/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Aminophylline use and the association between clinical outcomes and therapy timing have been less investigated. The objective of this study was to determine the efficacy of early aminophylline use (within the first two days of life) in premature infants. METHOD A retrospective observational cohort of infants weighing <1500 g and <30 weeks of gestational age at Kaohsiung Veterans General Hospital received aminophylline either within the first two days of life (EA, early aminophylline group), after the third day of life (LA, late aminophylline group), or without aminophylline during the first month of life (WA, without aminophylline group). Demographic data and neonatal clinical outcomes were compared among the three groups. RESULTS This study included 89 preterm infants (EA = 33, LA = 38, WA = 18). The EA group had a lower incidence of bronchopulmonary dysplasia (BPD) than the WA group (adjusted odds ratio [aOR] = 8.86(1.56-59.32); P = 0.024). Although there was no significant difference in BPD incidence between the EA and LA groups (aOR = 2.66(0.51-13.81), P = 0.244), a trend remained. Birth body weight less than 1000 g was also a significant risk factor for BPD (aOR = 8.86(1.32-47.41), P = 0.014). The duration of mechanical ventilation was shorter in the infants in the EA group compared to the WA group (estimated beta = -11.344(-19.57-3.12); P = 0.008). CONCLUSION Early aminophylline administration may be associated with a decreased incidence of BPD in preterm infants. However, the clinical benefits of aminophylline treatment require further investigation. In addition, a birth body weight of less than 1000 g was a crucial risk factor for BPD.
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Affiliation(s)
- Yi-Ting Chu
- Division of Pediatric Neonatology, Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Jin-Shuen Chen
- Department of Administration, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Yao-Shen Chen
- Department of Administration, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chih-Chieh Yang
- Division of Pediatric Neonatology, Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chun-Hao Yin
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Taiwan; Institute of Health Care Management, National Sun Yat-Sen University, Taiwan
| | - Hsiao-Ping Wang
- Division of Pediatric Neonatology, Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yee-Hsuan Chiou
- Division of Pediatric Nephrology, Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Medical Laboratory Sciences and Biotechnology, Fooyin University, Kaohsiung, Taiwan.
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Miller TL, Raab LM, Shaffer TH, Schweikert A, Diana F, Fort P, Frum AS, Pergolizzi J, Raffa RB. A Novel Agnostic Respiratory Stimulant as a Treatment for Apnea of Prematurity: A Proof-of-Concept Study. Cureus 2022; 14:e28900. [PMID: 36237747 PMCID: PMC9544529 DOI: 10.7759/cureus.28900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 09/06/2022] [Indexed: 11/17/2022] Open
Abstract
Aim/Objective: ENA-001 is a novel selective antagonist of large-conductance BK (big potassium) channels located in the carotid bodies, where they act as chemoreceptors that sense low arterial oxygen levels and establish a feedback loop to brainstem nuclei responsible for initiating spontaneous breathing and maintaining adequate oxygen to tissues. ENA-001 attenuates respiratory depression induced by a variety of chemical agents, essentially "agnostic" to the precipitating drug (e.g., opioid(s), benzodiazepine, alcohol, or propofol). But it had not been tested against respiratory depression resulting from a physiological cause, such as apnea of prematurity (AOP). This proof-of-principle study used a well-described animal model (premature lamb) to test the effectiveness of ENA-001 in the setting of an under-developed respiratory control system, similar to that in human AOP. Materials and Methods: A set of twin lambs was delivered prematurely via caesarian section at 135 ± 2 d gestational age (GA). An arterial catheter was connected to a transducer for pressure monitoring and a venous catheter was connected to a pump for continuous infusion of 5% dextrose in water (D5W). Lambs were to receive four mechanical breaths for lung recruitment and then started on continuous positive airway pressure (CPAP). After a stabilization period of 15 minutes, the protocol called for the first lamb to be started on continuous infusion of ENA-001, with ascending dose hourly (0.4, 1.1, 2.0, 12.0 mg/kg/hr), while the second lamb was to serve as a sham (D5W) control. At least 10 representative breaths free of artifact from motion or atypical breaths were recorded using a pulmonary function system designed for neonatal research. To maintain a stable plane of anesthesia, repeat doses of fentanyl (1 µg IM) were given as needed based on blood pressure response to stimulation. Results: Two male lambs were delivered. Unexpectedly, neither lamb exhibited a drive for spontaneous breathing. Each required manual ventilation, with a complete absence of spontaneous effort. Despite the poor prognosis owing to the absence of ventilatory effort, continuous infusion of the first dose of ENA-001 was started 20 minutes after birth. The test animal continued to require manual ventilation, which was continued for an additional 10 minutes. An intravenous (IV) bolus of ENA-001 was given. Nearly instantaneously following the delivery of the IV bolus, the lamb began breathing spontaneously and did not require manual intervention for the remainder of the study. The sham animal was delivered approximately an hour following the test animal. As with the test animal, the sham animal lacked spontaneous breathing efforts. A decision was made to manually ventilate for 30 minutes to match the course for the test animal. At the 30-minute time point, an IV bolus infusion of ENA-001 was delivered. Nearly instantaneously following the delivery of the IV bolus, the lamb began breathing spontaneously. After several minutes, the spontaneous breathing efforts abated, and manual ventilation was resumed. The animal was then sacrificed for tissue harvest. Conclusion: These results suggest that ENA-001 might be an effective therapy, alone or as a co-medication, for the treatment of AOP. They further suggest that ENA-001 might have broader applications in situations of neurological ventilatory insufficiency.
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Is Early Preventive Caffeine Safe and Effective in Premature Neonates? A Clinical Trial. Int J Pediatr 2022; 2022:8701598. [PMID: 35692738 PMCID: PMC9184212 DOI: 10.1155/2022/8701598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/16/2022] [Accepted: 05/17/2022] [Indexed: 11/30/2022] Open
Abstract
Background Advantages of caffeine for the treatment of apnea of prematurity (AOP) have prompted clinicians to use it as a preventive drug even before the occurrence of apnea. Objective To compare the effect of early preventive caffeine therapy with routine late preventive caffeine on the occurrence rate of apnea of prematurity, bronchopulmonary dysplasia (BPD) and related radiographic changes, necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), and patent ductus arteriosus (PDA), the need for mechanical ventilation, the length of mechanical ventilation, and the length of hospitalization. Materials and Methods In this open randomized clinical trial study, 90 preterm neonates with the gestational age of 25-35 weeks were divided into 2 groups: group A received caffeine during the first two days of life (early preventive caffeine), while group B received caffeine during the third to the tenth day of life (late preventive caffeine). The occurrence rate of AOP and other outcomes were the primary outcomes. The adverse effects of caffeine in each group were the secondary outcomes. Results The total occurrence rate of AOP was significantly higher (32.6%) in the late group versus (6.8%) in the early group (p = 0.002). The total occurrence rate of BPD was also significantly higher (37%) in the late group versus (18.2%) in the early group (p = 0.047). On the other hand, we found a lower need for mechanical ventilation, shorter length of mechanical ventilation, shorter length of hospitalization, and a lower occurrence rate of PDA, NEC, and IVH in the early group that was not significant. No adverse effect of caffeine was observed in each group. Conclusions Early preventive caffeine administration was associated with a significantly lower occurrence rate of AOP, BPD, and BPD radiologic changes. As other outcomes occurred lesser in the early group that were not significant, future studies with more participants are recommended. This study has been registered at the Iranian Registry of Clinical Trials (IRCT20160827029535N8).
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8
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Lin YC, Tan YL, Yen TA, Chen CY, Tsao PN, Chou HC. Specific Premature Groups Have Better Benefits When Treating Apnea With Caffeine Than Aminophylline/Theophylline. Front Pediatr 2022; 10:817624. [PMID: 35281246 PMCID: PMC8907829 DOI: 10.3389/fped.2022.817624] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/02/2022] [Indexed: 11/17/2022] Open
Abstract
Background Methylxanthines (caffeine; aminophylline/theophylline) are commonly used for apnea of prematurity (AOP) treatment. We aimed to compare the efficacy and adverse effects of caffeine and aminophylline/theophylline. Methods A retrospective case-control gestational age-matched study investigates patients born between January 2017 and December 2018, 23-35 weeks gestation with birth weights >500 g treating AOP with caffeine or aminophylline/theophylline. Results There were 144 cases (48 in caffeine group and 96 in aminophylline/theophylline group). The median treatment durations were 11 and 17 days in caffeine and aminophylline/theophyllinegroup (p = 0.002). When tachycardia is defined as heart rate ≥160 bpm, the rates were 8.3 and 34.4% in caffeine and control group (p = 0.001). When tachycardia is defined as 10 bpm over baseline heart rate, the rates were 41.7 and 63.5% in caffeine and aminophylline/theophylline group (p = 0.01). Stratified by gestational age and sex, significant reductions in tachycardia rates with caffeine than with theophylline were limited to male infants and infants born at <30 weeks gestation. Conclusions For apnea treatment, caffeine has greater efficacy and fewer tachycardia than aminophylline/theophylline, especially in male infants and infants born at <30 weeks gestation.
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Affiliation(s)
- Yi-Chieh Lin
- Department of Pediatrics, National Taiwan University Children Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Pediatrics, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Yin-Ling Tan
- Department of Pediatrics, National Taiwan University Children Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ting-An Yen
- Department of Pediatrics, National Taiwan University Children Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Yi Chen
- Department of Pediatrics, National Taiwan University Children Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Po-Nien Tsao
- Department of Pediatrics, National Taiwan University Children Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hung-Chieh Chou
- Department of Pediatrics, National Taiwan University Children Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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9
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Pergolizzi J, Kraus A, Magnusson P, Breve F, Mitchell K, Raffa R, LeQuang JAK, Varrassi G. Treating Apnea of Prematurity. Cureus 2022; 14:e21783. [PMID: 35251853 PMCID: PMC8890764 DOI: 10.7759/cureus.21783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/27/2022] [Indexed: 11/05/2022] Open
Abstract
Premature babies often suffer apnea of prematurity as a physiological consequence of an immature respiratory system. Hypercapnia may develop, and neonates with apnea of prematurity are at an increased risk of morbidity and mortality. The long-term effects of apnea of prematurity or their treatments are less clear. While a number of treatment options exist for apnea of prematurity, there is no clear-cut "first-line" approach or gold standard of care. Effective treatments, such as caffeine citrate, carbon dioxide inhalation, nasal continuous positive airway pressure, nasal intermittent positive pressure ventilation, and others, may be associated with safety concerns. More conservative treatments are available, such as kangaroo care, postural changes, and sensory stimulation, but they may not be effective. While apnea of prematurity resolves spontaneously as the respiratory system matures, it can complicate neonatal care and may have both short-term and long-term consequences. The role, if any, that apnea of prematurity may play in mortality of preterm neonates is not clear.
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Affiliation(s)
| | - Alexander Kraus
- Research and Development, Enalare Therapeutics, Inc., Lorrach, DEU
| | - Peter Magnusson
- Cardiology, Center of Research and Development Region Gävleborg/Uppsala University, Gävle, SWE
- Medicine, Cardiology Research Unit, Karolinska Institutet, Stockholm, SWE
| | - Frank Breve
- Pharmacy, Temple University, Philadelphia, USA
| | | | - Robert Raffa
- School of Pharmacy, Temple University (Emeritus), Philadelphia, USA
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10
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Pergolizzi JV, Fort P, Miller TL, LeQuang JA, Raffa RB. The limited management options for apnoea of prematurity. J Clin Pharm Ther 2021; 47:396-401. [PMID: 34734423 DOI: 10.1111/jcpt.13547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/15/2021] [Accepted: 10/08/2021] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE About 10% of all infants are born prematurely. Almost all of those of gestational age less than about 30 weeks, and about half of those of gestational age up to about 35 weeks, are subject to unpredictable interruptions of breathing-known as "apnoea of prematurity" (AOP). We present a synopsis of the problem and point out the limited management options. COMMENT A basal rate for spontaneous breathing is normally maintained by integrated action of generator cells in the brainstem and feedback from central and peripheral chemosensors. In AOP, there are intermittent periods (seconds) lacking spontaneous firing, which results in hypoxia and hypercapnia. The long-term consequences of these interruptions in oxygen supply to tissues are not known. Although many treatment modalities are used, including drug therapy, nonpharmacologic care and mechanical intervention, there is no universally effective first-line management for AOP. Caffeine citrate is generally the most frequently used pharmacotherapeutic agent, but its side effect profile narrows with higher doses and the upper limit is still being investigated to discern the greatest benefit-to-risk ratio; thus, most infants do not achieve complete resolution of apnoeas. WHAT IS NEW AND CONCLUSION Given the widespread and serious nature of the problem of AOP, there is a surprising lack of treatment options. A more consistent and effective treatment, alone or as adjunct, would be welcome.
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Affiliation(s)
- Joseph V Pergolizzi
- NEMA Research Inc., Naples, FL, USA.,Neumentum Inc., Summit, NJ, USA.,Enalare Therapeutics Inc., Princeton, NJ, USA
| | - Prem Fort
- Neonatology, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thomas L Miller
- Enalare Therapeutics Inc., Princeton, NJ, USA.,Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Robert B Raffa
- Neumentum Inc., Summit, NJ, USA.,Enalare Therapeutics Inc., Princeton, NJ, USA.,College of Pharmacy (Adjunct), University of Arizona, Tucson, AZ, USA.,School of Pharmacy (Prof. emer.), Temple University, Philadelphia, PA, USA
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11
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Varisco G, Kommers D, Long X, Zhan Z, Nano MM, Cottaar W, Andriessen P, Pul CV. Optimized Detection of Central Apneas Preceding Late-Onset Sepsis in Premature Infants. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:5463-5468. [PMID: 34892362 DOI: 10.1109/embc46164.2021.9629528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In neonatal intensive care units, respiratory traces of premature infants developing late onset sepsis (LOS) may also show episodes of apneas. However, since clinical patient monitors often underdetect apneas, clinical experts are required to investigate patients' traces looking for these events. In this work we present a method to optimize an existing algorithm for central apnea (CA) detection and how we used it together with human annotations to investigate the occurrence of CAs preceding LOS.The algorithm was optimized by using a previously-annotated dataset consisting of 90 hours, extracted from 10 premature infants. This allowed to double precision (19.7% vs 9.3%, median values per patient) without affecting recall (90.5% vs 94.5%) compared to the original algorithm. This choice caused the missed identification of just 1 additional CA (4 vs 3) in the whole dataset. The optimized algorithm was then used to annotate a second dataset consisting of 480 hours, extracted from 10 premature infants diagnosed with LOS. Annotations were corrected by two clinical experts.A significantly higher number of CA annotations was found in the 6 hours prior to sepsis onset (p-value < 0.05). The use of the optimized algorithm followed by human annotations proved to be a suitable, time-efficient method to annotate CAs before sepsis in premature infants, enabling future use in large datasets.
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12
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Zeldich D, Bou Jawde S, Herrmann J, Arnaout L, Griffin M, Grunfeld N, Zhang Y, Krishnan R, Bartolák-Suki E, Suki B. Stabilizing breathing pattern using local mechanical vibrations: comparison of deterministic and stochastic stimulations in rodent models of apnea of prematurity. Biomed Eng Lett 2021; 11:383-392. [PMID: 34490067 PMCID: PMC8409477 DOI: 10.1007/s13534-021-00203-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/17/2021] [Accepted: 08/20/2021] [Indexed: 11/26/2022] Open
Abstract
Mechanical stimulation has been shown to reduce apnea of prematurity (AOP), a major concern in preterm infants. Previous work suggested that the underlying mechanism is stochastic resonance, amplification of a subthreshold signal by stochastic stimulation. We hypothesized that the mechanism behind the reduction of apnea length may not be a solely stochastic phenomenon, and suggest that a purely deterministic, non-random mechanical stimulation could be equally as effective. Mice and rats were anesthetized, tracheostomized, and mechanically ventilated to halt spontaneous breathing. Two miniature motors controlled by a microcontroller were attached around the abdomen. Ventilation was paused, stimulations were applied, and the time to the rodent's first spontaneous breath (T) was measured. Six spectrally different signals were compared to one another and the no-stimulation control in mice. The most successful deterministic stimulation (D) at reducing apnea was then compared to a pseudo-random noise (PRN) signal of comparable amplitude and frequency. CO2%, CO2 stabilization time (Ts), O2 saturation (SpO2%), and T were also measured. D significantly reduced T compared to no stimulation for medium and high amplitudes. PRN also reduced T, without a difference between D and PRN. Furthermore, both stimulations significantly reduced Ts with no significant differences between the respective stimulations. However, there was no effect of D or PRN on SpO2%. The lack of differences between D and PRN led to an additional series of experiment comparing the same D to a band-limited white noise (WN) signal in young rats. Both D and WN were shown to significantly reduce T, with D showing statistical superiority in reduction of apnea. We further speculate that both deterministic and stochastic mechanical stimulations induce some form of mechanotransduction which is responsible for their efficacy, and our findings suggest that mechanical stimulation may be effective in treating AOP. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s13534-021-00203-x.
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Affiliation(s)
- Dean Zeldich
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Boston, MA 02215 USA
| | - Samer Bou Jawde
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Boston, MA 02215 USA
| | - Jacob Herrmann
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Boston, MA 02215 USA
| | - Leen Arnaout
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Boston, MA 02215 USA
| | - Meghan Griffin
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Boston, MA 02215 USA
| | - Noam Grunfeld
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Boston, MA 02215 USA
| | - Yu Zhang
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Boston, MA 02215 USA
| | - Ramaswamy Krishnan
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA
| | - Erzsébet Bartolák-Suki
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Boston, MA 02215 USA
| | - Béla Suki
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Boston, MA 02215 USA
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13
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Zuzarte I, Sternad D, Paydarfar D. Predicting apneic events in preterm infants using cardio-respiratory and movement features. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 209:106321. [PMID: 34380078 PMCID: PMC8898595 DOI: 10.1016/j.cmpb.2021.106321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 07/25/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Preterm neonates are prone to episodes of apnea, bradycardia and hypoxia (ABH) that can lead to neurological morbidities or even death. There is broad interest in developing methods for real-time prediction of ABH events to inform interventions that prevent or reduce their incidence and severity. Using advances in machine learning methods, this study develops an algorithm to predict ABH events. METHODS Following previous studies showing that respiratory instabilities are closely associated with bouts of movement, we present a modeling framework that can predict ABH events using both movement and cardio-respiratory features derived from routine clinical recordings. In 10 preterm infants, movement onsets and durations were estimated with a wavelet-based algorithm that quantified artifactual distortions of the photoplethysmogram signal. For prediction, cardio-respiratory features were created from time-delayed correlations of inter-beat and inter-breath intervals with past values; movement features were derived from time-delayed correlations with inter-breath intervals. Gaussian Mixture Models and Logistic Regression were used to develop predictive models of apneic events. Performance of the models was evaluated with ROC curves. RESULTS Performance of the prediction framework (mean AUC) was 0.77 ± 0.04 for 66 ABH events on training data from 7 infants. When grouped by the severity of the associated bradycardia during the ABH event, the framework was able to predict 83% and 75% of the most severe episodes in the 7-infant training set and 3-infant test set, respectively. Notably, inclusion of movement features significantly improved the predictions compared with modeling with only cardio-respiratory signals. CONCLUSIONS Our findings suggest that recordings of movement provide important information for predicting ABH events in preterm infants, and can inform preemptive interventions designed to reduce the incidence and severity of ABH events.
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Affiliation(s)
- Ian Zuzarte
- Department of Bioengineering, Northeastern University, Boston, MA 02115, United States
| | - Dagmar Sternad
- Departments of Biology, Electrical and Computer Engineering & Physics, Northeastern University, Boston, MA 02115, United States
| | - David Paydarfar
- Department of Neurology, Dell Medical School, Austin, TX 78712, United States; Oden Institute for Computational Sciences and Engineering, The University of Texas at Austin, Austin, TX 78712, United States.
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14
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Rosen C, Taran C, Hanna M, Gueta I, Loebstein R, Strauss T, Yarden-Bilavsky H. Caffeine citrate for apnea of prematurity-One dose does not fit all a prospective study. J Perinatol 2021; 41:2292-2297. [PMID: 34290376 DOI: 10.1038/s41372-021-01172-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/24/2021] [Accepted: 07/14/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Caffeine citrate is the most frequently used medication in preterm neonates for the prevention of apnea of prematurity. There is no accepted consensus regarding the optimal caffeine citrate dosing. In this study, we evaluate clinical responses of premature neonates to standard-dose caffeine citrate treatment. METHODS A prospective observational study conducted at the NICU at Sheba Medical Center (3/2016-2/2017). The study population included preterm neonates born at a gestational age (GA) < 33 weeks and treated with caffeine citrate according to the local NICU protocol. RESULTS The study cohort included 66 preterm neonates of GA < 33 weeks. Thirty infants were defined as responders and 36 as nonresponders to 7.5 mg/kg caffeine citrate treatment, and they required a further dose increase to 10 mg/kg. Infants in the nonresponders group were born at earlier GA than responders (29 vs. 31 weeks, respectively, P = 0.004). The nonresponders required a significantly longer hospital stay (56 vs. 46 days, P = 0.014), and longer supplemental oxygen support (18 vs 2 days, P = 0.008). CONCLUSIONS Caffeine citrate initiation at higher doses is safe and does not require routine serum levels monitoring. It might be more effective for controlling apnea of prematurity in preterm neonates born ≤29 weeks of gestation.
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Affiliation(s)
- Chava Rosen
- Department of Neonatology, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel. .,The Talpiot Medical Leadership Program, Sheba Medical Center, Tel-Hashomer, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Camilia Taran
- Department of Neonatology, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Marwan Hanna
- Department of Neonatology, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Itai Gueta
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Clinical Pharmacology and Toxicology, Sheba Medical Center, Tel Hashomer, Israel.,Department of Internal Medicine A, Sheba Medical Center, Tel Hashomer, Israel
| | - Ronen Loebstein
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Clinical Pharmacology and Toxicology, Sheba Medical Center, Tel Hashomer, Israel
| | - Tzipora Strauss
- Department of Neonatology, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Havatzelet Yarden-Bilavsky
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Clinical Pharmacology and Toxicology, Sheba Medical Center, Tel Hashomer, Israel.,Department of Pediatrics A, Schneider Children's Medical Center, Petach Tikva, both affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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15
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van Leuteren RW, de Waal CG, Hutten GJ, de Jongh FH, van Kaam AH. Transcutaneous monitoring of diaphragm activity as a measure of work of breathing in preterm infants. Pediatr Pulmonol 2021; 56:1593-1600. [PMID: 33524225 PMCID: PMC8248030 DOI: 10.1002/ppul.25284] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/06/2021] [Accepted: 01/13/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Monitoring work of breathing (WOB) is important to assess the pulmonary condition and adjust respiratory support in preterm infants. Conventional WOB measurement (esophageal pressure, tidal volume) is invasive and we hypothesized that monitoring diaphragm activity could be a noninvasive alternative to estimate WOB. The objective was to determine the correlation between conventional WOB measures and diaphragm activity, in preterm infants. METHODS WOB and diaphragm activity, measured with transcutaneous electromyography (dEMG), were simultaneously recorded at different nasal continuous positive airway pressure (nCPAP) levels. During a 30-s recording at each nCPAP level, dEMG parameters, inspiratory WOB (WOBi ), and pressure time product (PTPin ) were calculated per breath. The correlation coefficient between WOB- and dEMG-measures was calculated using single breaths and after aggregating all breaths into deciles of incremental WOBi . RESULTS Fifteen preterm infants were included (median gestational age, 28 weeks). Single-breath analysis showed a poor median correlation of 0.27 (interquartile range [IQR], 0.03 to 0.33) and 0.08 (IQR, -0.03 to 0.28), respectively, for WOBi and PTPin with peak diaphragmatic activity (dEMGpeak ). A modest median correlation coefficient of 0.65 (IQR, 0.13 to 0.79) and 0.43 (IQR, -0.33 to 0.69) was found for, respectively, WOBi and PTPin with dEMGpeak in the aggregated analysis. CONCLUSION Diaphragm activity showed a modest correlation with WOBi and PTPin in an aggregated analysis. This finding warrants further studies in infants with more significant lung disease.
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Affiliation(s)
- Ruud W van Leuteren
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Cornelia G de Waal
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Gerard J Hutten
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Frans H de Jongh
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
| | - Anton H van Kaam
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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16
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Zhang CY, Liu DJ, Hua SD, Guo S, Li XY, Zhang B, An LH. Caffeine versus aminophylline in combination with oxygen therapy for apnea of prematurity: A retrospective cohort study. Exp Ther Med 2020; 20:46. [PMID: 32952637 PMCID: PMC7480137 DOI: 10.3892/etm.2020.9175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 04/09/2020] [Indexed: 11/25/2022] Open
Abstract
The present study was conducted to investigate the clinical significance of caffeine and aminophylline in the treatment of premature infants with apnea under varying conditions of oxygen (O2) delivery. The clinical data of 120 premature infants with apnea treated with oxygen therapy and either caffeine citrate (20 mg/kg/day; n=77) or aminophylline (10 mg/kg/day; n=43) were retrospectively examined. The therapeutic performance of the drugs after the completion of the treatment was evaluated primarily according to the risk of recurrent episodes of apnea, the changes in the duration and concentration of inhaled O2 and the incidence of complications. In contrast to aminophylline, caffeine treatment significantly reduced the duration of O2 inhalation and the inhaled O2 concentration in the infants treated with mechanical ventilation or O2 delivery devices (P<0.05). Treatment with caffeine also decreased the incidence of recurrent apnea events and complications in the investigated population (P<0.05 or P<0.01). Caffeine performs better than aminophylline in the treatment of premature infants with apnea under different conditions of O2 delivery. The therapeutic performance of caffeine is achieved primarily via improving the efficacy of supplemental O2 and reducing the incidence of complications.
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Affiliation(s)
- Cheng-yun Zhang
- Department of Neonatology, The First People's Hospital of Zhengzhou City, Zhengzhou, Henan 450000, P.R. China
| | - Dong-jie Liu
- Department of Neonatology, The First People's Hospital of Zhengzhou City, Zhengzhou, Henan 450000, P.R. China
| | - Shao-dong Hua
- Newborn Intensive Care Unit, The Seventh Medical Center of The Chinese People's Liberation Army, Affiliated Bayi Children's Hospital, Beijing 100700, P.R. China
| | - Shan Guo
- Department of Obstetrics, The First People's Hospital of Zhengzhou City, Zhengzhou, Henan 450000, P.R. China
| | - Xiao-yan Li
- Department of Neonatology, The First People's Hospital of Zhengzhou City, Zhengzhou, Henan 450000, P.R. China
| | - Bing Zhang
- Department of Neonatology, The First People's Hospital of Zhengzhou City, Zhengzhou, Henan 450000, P.R. China
| | - Li-hua An
- Department of Neonatology, The First People's Hospital of Zhengzhou City, Zhengzhou, Henan 450000, P.R. China
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17
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Early application of caffeine improves white matter development in very preterm infants. Respir Physiol Neurobiol 2020; 281:103495. [DOI: 10.1016/j.resp.2020.103495] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/22/2020] [Accepted: 07/12/2020] [Indexed: 12/31/2022]
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18
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Caffeine and Gastric Emptying Time in Very Preterm Neonates. J Clin Med 2020; 9:jcm9061676. [PMID: 32492933 PMCID: PMC7356267 DOI: 10.3390/jcm9061676] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Caffeine has been commonly used for prevention and treatment of apnea-related symptoms in premature infants. However, its side effects have not been thoroughly studied. We investigated whether caffeine affects gastric motility in very-preterm (VP) neonates. Methods: The study is a randomized crossover clinical trial. Twenty-two neonates with mean birth weight (BW) (standard deviation—SD) 1077 (229) g and mean gestational age (GA) (SD) 28.6 (2.1) weeks were recruited. Each neonate had its gastric emptying time checked twice with ultrasound assessment of changes in antral cross sectional area (ACSA). All neonates were sequentially allocated to the caffeine group (A) and the control group (B). Complications from the gastrointestinal tract were documented throughout the study. Results: Statistically significant difference was found with regards to the gastric emptying time [median, (range)] between caffeine and control group (p = 0.040). Additionally, in the neonates with BW 1000–1500 g and GA ≥ 28 weeks, the gastric emptying time (minutes) was significantly longer during caffeine treatment [44.5 (36–68.2)] and [40 (34.5–66.5)] respectively, as compared to the gastric emptying time during no caffeine treatment [27 (24.2–30)] (p = 0.002) and [27 (24.5–30)] (p = 0.001). The incidence of gastrointestinal (GI) complications was significantly greater in neonates receiving caffeine [6 (27.%)] as compared with those without caffeine treatment [1 (4.6%)] (p = 0.039). Conclusions: During caffeine treatment, a significantly delayed gastric emptying time was noted in all study neonates, especially in these with BW 1000–1500 g and those with GA ≥ 28 weeks. Further larger studies are necessary in order to confirm this interesting finding.
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Ji D, Smith PB, Clark RH, Zimmerman KO, Laughon M, Ku L, Greenberg RG. Wide variation in caffeine discontinuation timing in premature infants. J Perinatol 2020; 40:288-293. [PMID: 31758062 PMCID: PMC7222934 DOI: 10.1038/s41372-019-0561-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/29/2019] [Accepted: 11/13/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess site variability and concomitant respiratory support related to the timing of caffeine discontinuation, and compare clinical characteristics of infants who discontinued caffeine before vs. within the last week of hospitalization. STUDY DESIGN Cohort study of 81,110 infants <35 weeks gestational age and <1500 g birth weight discharged from 304 neonatal intensive care units from 2001-2016. RESULTS The mean postmenstrual age at caffeine discontinuation ranged from 32 to 37 weeks among sites. Respiratory support at the time of discontinuation was common, but variable, with 0-57% of infants receiving positive airway pressure at caffeine discontinuation by site. Infants who discontinued caffeine within the last week of hospitalization had longer total duration of caffeine, but were discharged from the hospital at an earlier postmenstrual age. CONCLUSION There was substantial variability among sites in the timing of caffeine discontinuation before discharge and respiratory support at the time of caffeine discontinuation.
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Affiliation(s)
- Dabin Ji
- grid.259907.0Mercer University School of Medicine, Savannah, GA USA
| | - P. Brian Smith
- 0000 0004 1936 7961grid.26009.3dDepartment of Pediatrics, Duke University, Durham, NC USA ,0000 0004 1936 7961grid.26009.3dDuke Clinical Research Institute, Durham, NC USA
| | - Reese H. Clark
- 0000 0004 0640 3724grid.459894.dPediatrix Medical Group, Sunrise, FL USA
| | - Kanecia O. Zimmerman
- 0000 0004 1936 7961grid.26009.3dDepartment of Pediatrics, Duke University, Durham, NC USA
| | - Matthew Laughon
- 0000000122483208grid.10698.36Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Lawrence Ku
- 0000 0004 1936 7961grid.26009.3dDepartment of Pediatrics, Duke University, Durham, NC USA
| | - Rachel G. Greenberg
- 0000 0004 1936 7961grid.26009.3dDepartment of Pediatrics, Duke University, Durham, NC USA ,0000 0004 1936 7961grid.26009.3dDuke Clinical Research Institute, Durham, NC USA
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20
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Makarenko VV, Peng YJ, Khan SA, Nanduri J, Fox AP, Prabhakar NR. Long-term facilitation of catecholamine secretion from adrenal chromaffin cells of neonatal rats by chronic intermittent hypoxia. J Neurophysiol 2019; 122:1874-1883. [PMID: 31483699 DOI: 10.1152/jn.00435.2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In neonates, catecholamine (CA) secretion from adrenal medullary chromaffin cells (AMC) is an important mechanism for maintaining homeostasis during hypoxia. Nearly 90% of premature infants experience chronic intermittent hypoxia (IH) because of high incidence of apnea of prematurity, which is characterized by periodic stoppage of breathing. The present study examined the effects of repetitive hypoxia, designed to mimic apnea of prematurity, on CA release from AMC of neonatal rats. Neonatal rats were exposed to either control conditions or chronic intermittent hypoxia (IH) from ages postnatal days 0-5 (P0-P5), and CA release from adrenal medullary slices was measured after challenge with repetitive hypoxia (5 episodes of 30-s hypoxia, Po2 ~35 mmHg). In response to repetitive hypoxia, chronic IH-treated AMC exhibited sustained CA release, and this phenotype was not seen in control AMC. The sustained CA release was associated with long-lasting elevation of intracellular Ca2+ concentration ([Ca2+]i), which was due to store-operated Ca2+ entry (SOCE). 2-Aminoethoxydiphenyl borate, an inhibitor of SOCE, prevented the long-lasting [Ca2+]i elevation and CA release. Repetitive hypoxia increased H2O2 abundance, and polyethylene glycol (PEG)-catalase, a scavenger of H2O2 blocked this effect. PEG-catalase also prevented repetitive hypoxia-induced SOCE activation, sustained [Ca2+]i elevation, and CA release. These results demonstrate that repetitive hypoxia induces long-term facilitation of CA release in chronic IH-treated neonatal rat AMC through sustained Ca2+ influx mediated by SOCE.NEW & NOTEWORTHY Apnea of prematurity and the resulting chronic intermittent hypoxia are major clinical problems in neonates born preterm. Catecholamine release from adrenal medullary chromaffin cells maintains homeostasis during hypoxia in neonates. Our results demonstrate that chronic intermittent hypoxia induces a hitherto uncharacterized long-term facilitation of catecholamine secretion from neonatal rat chromaffin cells in response to repetitive hypoxia, simulating hypoxic episodes encountered during apnea of prematurity. The sustained catecholamine secretion might contribute to cardiovascular morbidities in infants with apnea of prematurity.
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Affiliation(s)
- Vladislav V Makarenko
- Institute for Integrative Physiology and Center for Systems Biology of O2 Sensing, University of Chicago, Chicago, Illinois
| | - Ying-Jie Peng
- Institute for Integrative Physiology and Center for Systems Biology of O2 Sensing, University of Chicago, Chicago, Illinois
| | - Shakil A Khan
- Institute for Integrative Physiology and Center for Systems Biology of O2 Sensing, University of Chicago, Chicago, Illinois
| | - Jayasri Nanduri
- Institute for Integrative Physiology and Center for Systems Biology of O2 Sensing, University of Chicago, Chicago, Illinois
| | - Aaron P Fox
- Institute for Integrative Physiology and Center for Systems Biology of O2 Sensing, University of Chicago, Chicago, Illinois
| | - Nanduri R Prabhakar
- Institute for Integrative Physiology and Center for Systems Biology of O2 Sensing, University of Chicago, Chicago, Illinois
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21
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Ye C, Miao C, Yu L, Dong Z, Zhang J, Mao Y, Lu X, Lyu Q. Factors affecting the efficacy and safety of aminophylline in treatment of apnea of prematurity in neonatal intensive care unit. Pediatr Neonatol 2019; 60:43-49. [PMID: 29673564 DOI: 10.1016/j.pedneo.2018.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 03/12/2018] [Accepted: 03/27/2018] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND The factors affecting the safety and efficacy of aminophylline use in the treatment of apnea of prematurity (AOP) in the neonatal intensive care unit (NICU) are not clear. In this study, we aimed to evaluate the potential factors affecting the efficacy and safety of aminophylline in AOP treatment at standard doses and to determine appropriate patients for this therapy. METHODS Over a 3-year period (January 2012 to December 2014), the medical records of 206 preterm infants with apnea who were admitted to the NICU of our hospital to receive aminophylline infusions were retrospectively reviewed. These infants were subjected to routine theophylline monitoring by reversed-phase high performance liquid chromatography. The primary outcome measures were the efficacy of aminophylline treatment and adverse reactions observed upon administration. RESULTS One-hundred and twenty-seven (61.65%) infants were considered to have undergone effective therapy and classified accordingly. Gestational age, body weight at the initiation of aminophylline, and serum theophylline concentration were identified as protective factors of therapeutic efficacy. Receiver operating characteristic (ROC) analysis indicated cutoff values of 30.36 weeks for gestational age and 1.69 kg for body weight at initiation of aminophylline administration for ensuring high efficacy of aminophylline for AOP. Fifty-three (25.73%) infants had adverse reactions. Birth weight and serum concentration of theophylline were associated with an increased risk of adverse reactions, with odds ratios of 0.167 and 1.346, respectively. The ROC curves indicated a birth weight cutoff value of 1.48 kg. CONCLUSION Infants with apnea and gestational age >30.36 weeks, body weight at initiation of aminophylline treatment above 1.69 kg, and birth weight >1.48 kg are suitable for treatment with aminophylline. Monitoring of serum theophylline concentration should be implemented in the absence of clinical response or in case of suspected adverse reactions.
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Affiliation(s)
- Chaohui Ye
- Department of Pharmacy, Ningbo Women & Children Hospital, Ningbo 315012, Zhejiang, China
| | - Caiyun Miao
- Department of Pharmacy, Ningbo Women & Children Hospital, Ningbo 315012, Zhejiang, China
| | - Li Yu
- Department of Pharmacy, The Affiliated Hospital of Medical School of Ningbo University, Ningbo 315020, Zhejiang, China
| | - Zhuoya Dong
- Department of Neonatal Intensive Care Unit, Ningbo Women & Children Hospital, Ningbo 315012, Zhejiang, China
| | - Jie Zhang
- Department of Pharmacy, Ningbo Women & Children Hospital, Ningbo 315012, Zhejiang, China
| | - Yingying Mao
- Department of Pharmacy, Ningbo Women & Children Hospital, Ningbo 315012, Zhejiang, China
| | - Xiaodong Lu
- Department of Pharmacy, Ningbo Women & Children Hospital, Ningbo 315012, Zhejiang, China
| | - Qin Lyu
- Department of Neonatal Intensive Care Unit, Ningbo Women & Children Hospital, Ningbo 315012, Zhejiang, China.
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Bou Jawde S, Scheuermann A, Bartolák-Suki E, Suki B. The effect of mechanical or electrical stimulation on apnea length in mice. Biomed Eng Lett 2019; 8:329-335. [PMID: 30603217 DOI: 10.1007/s13534-018-0076-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 06/06/2018] [Accepted: 06/17/2018] [Indexed: 10/28/2022] Open
Abstract
Premature birth is a leading cause of infant mortality which is often attributed to irregular breathing and apnea of prematurity. A common treatment for apnea is caffeine to stimulate the brain's respiratory center. However, caffeine's long term effect on infant development is not fully comprehended. We hypothesized that noninvasive localized body stimulation regularizes breathing pattern. We investigated the impact of electrical or mechanical stimulation on breathing in mice. After the mice were ventilated for 28 s to induce apnea, mice were taken off the ventilator while receiving mechanical, electrical, or no stimulation in a randomized order. Both stimuli targeted the diaphragm area through a custom-built belt with vibrating motors or adhesive electrodes. After each apnea cycle, the time to take the first breath (T) was recorded. The electrical stimulation given at 4.5, 8.3, 16.7 V (pulse rate = 3 Hz, pulse width = 120 μs) showed no reduction in T. Electrical stimulation at pulse rates of 10 or 20 Hz (16.7 V, pulse width 260 μs) showed a detrimental effect increasing T by ~ 7% compared to control values (p = 0.005, p = 0.038 respectively). High and medium intensity mechanical stimulations significantly reduced T by 11.74 (p < 10-13) and by 17.08% (p < 10-8), respectively. Further reducing the amplitude of vibrations did not affect T. When the probe was attached to the ankles, only the high intensity vibrations resulted in a decrease in T (p < 10-13). Mechanical vibrations, applied at various intensities and locations, could be used to treat irregular breathing and apnea in infants.
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Affiliation(s)
- Samer Bou Jawde
- 1Department of Biomedical Engineering, Boston University, Boston, MA USA
| | - Alexandra Scheuermann
- 1Department of Biomedical Engineering, Boston University, Boston, MA USA.,2Duke University, Durham, NC USA
| | | | - Béla Suki
- 1Department of Biomedical Engineering, Boston University, Boston, MA USA
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Abstract
This study explored the feasibility effect and safety of the limb stimulation (LS) for the treatment of neonatal apnea (NAP).The cases of 30 eligible premature infants with NAP were included in this retrospective study. These cases were equally divided into an intervention group (n = 15) and a control group (n = 15). The infants in both groups received caffeine treatment. Moreover, cases in the intervention group also received LS for a total 30 hours, while the subjects in the control group did not receive LS during this period. The primary outcome included apnea frequency (number of episodes per 24 hours), and apnea rate. The secondary outcomes consisted of desaturation (number of episodes per 24 hours), and heart rate (beats per minute). Additionally, adverse events were also documented during the treatment period.After treatment, LS did not show better outcomes in apnea frequency (P = .48), apnea rate (P = .33), desaturation (P = .55), and heart rate (P = .41). Furthermore, no significant differences of all adverse events were found between 2 groups.The results of this pilot study demonstrated that LS might be not efficacious for premature infants with NAP.
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Affiliation(s)
| | | | | | - Shuang Qiao
- Department of Neonatology, Second Affiliated Hospital of Mudanjiang Medical University, Mudanjiang, China
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24
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Abu-Sa'da OS, Armstrong EA, Scott O, Shaw O, Nguyen AT, Shen K, Cheung PY, Baker G, Yager JY. The Effect of Caffeine on the Neuropathological and Neurobehavioral Outcome in the Newborn Rat. J Caffeine Adenosine Res 2018. [DOI: 10.1089/caff.2017.0036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Omar S. Abu-Sa'da
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- Department of Neonatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Edward A. Armstrong
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- Faculty of Medicine and Dentistry, Centre for Neuroscience, University of Alberta, Edmonton, Canada
| | - Ori Scott
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Oriana Shaw
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Antoinette T. Nguyen
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- Faculty of Medicine and Dentistry, Centre for Neuroscience, University of Alberta, Edmonton, Canada
| | - Keqin Shen
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- Department of Pediatric Neurosciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Po-Yin Cheung
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- Department of Neonatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Glen Baker
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Jerome Y. Yager
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- Faculty of Medicine and Dentistry, Centre for Neuroscience, University of Alberta, Edmonton, Canada
- Department of Pediatric Neurosciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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Philip RK, Ismail A, Murphy B, Mirza A, Quinn C, Dunworth M. Caffeine Treatment for Apnea of Prematurity and the Influence on Dose-Dependent Postnatal Weight Gain Observed Over 15 Years. J Caffeine Adenosine Res 2018; 8:99-106. [PMID: 30250944 PMCID: PMC6150932 DOI: 10.1089/caff.2018.0005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background and Aim: To analyze the influence on weight gain of infants exposed to two dosage regimens of oral caffeine citrate (CC) for apnea of prematurity. Methods: Retrospective descriptive observational study of an eligible very low birth weight cohort over a 15-year period in an Irish University hospital. Data were analyzed between two distinct postnatal ages: 14–28 and 29–56 days. Results: During the 15-year study, 457 infants were prescribed caffeine. Among the 14–28-day group, after applying exclusion criteria, 418 infants qualified. Two hundred forty-eight infants received 5 mg/(kg·day) and 170 received 10 mg/(kg·day) of CC. Among the 29–56-day group, 362 infants were identified and after applying exclusions, 332 fulfilled entry criteria [214 on 5 mg/(kg·day) and 118 on 10 mg/(kg·day) regimen]. Baseline characteristics of infants were comparable between groups without statistically significant differences. Mean daily weight gain (MDWG) in grams from day 14 to 28 showed a higher rate of increase for the 5 mg/(kg·day) group compared with the 10 mg/(kg·day) group (17.2 ± 12 g vs. 13.0 ± 10.2 g [p = 0.04]). From day 29 to 56, also MDWG was higher among infants on 5 mg/(kg·day) of CC compared with 10 mg/(kg·day) group (15.6 ± 10.8 g vs. 10.2 ± 9.8 g [p = 0.011]). Conclusion: While a variety of measures are optimized to promote postnatal weight gain of premature infants close to an ideal intrauterine growth curve, not paying sufficient attention to one of the most widely used catabolic agents in neonatology is questionable and warrants vigilance. Additional nutritional measures could be offered to those with prolonged caffeine exposure.
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Affiliation(s)
- Roy K Philip
- Division of Neonatology, Department of Paediatrics, University Maternity Hospital Limerick (UMHL), Limerick, Ireland.,Graduate Entry Medical School (GEMS), University of Limerick, Limerick, Ireland
| | - Abu Ismail
- Division of Neonatology, Department of Paediatrics, University Maternity Hospital Limerick (UMHL), Limerick, Ireland
| | - Bernadette Murphy
- Department of Pharmacy, University Hospital Limerick (UHL), Limerick, Ireland
| | - Adnan Mirza
- Division of Neonatology, Department of Paediatrics, University Maternity Hospital Limerick (UMHL), Limerick, Ireland
| | - Collette Quinn
- Midwifery and Neonatal Nursing, University Maternity Hospital Limerick (UMHL), Limerick, Ireland
| | - Margo Dunworth
- Midwifery and Neonatal Nursing, University Maternity Hospital Limerick (UMHL), Limerick, Ireland
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Khurana S, Shivakumar M, Sujith Kumar Reddy GV, Jayashree P, Ramesh Bhat Y, Lewis LES. Long-term neurodevelopment outcome of caffeine versus aminophylline therapy for apnea of prematurity. J Neonatal Perinatal Med 2018; 10:355-362. [PMID: 29286928 DOI: 10.3233/npm-16147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Methylxanthines are the most commonly prescribed drug in neonatal setups. However, Clinicians show indecision in choosing the right agent for Apnea of Prematurity in most of the developing countries. Present study aimed to compare rate of mortality and survival with normal neurodevelopment outcome at 18 to 24 months of corrected age, between Caffeine- and Aminophylline-treated infants for apnea of prematurity. METHODS 240 infants were randomly allocated to caffeine and aminophylline for apnea of prematurity during February 2012 to January 2015. Long-term neurodevelopmental assessment was done only from children who had attained corrected age of 18 to 24 months during April 2014 to February 2016. Cognitive, language and motor deficits were assessed by Bayley Scale of infant and toddler development (BSID - III). Postnatal characteristics such as hearing and visual impairments during NICU stay were noted and same were followed up. RESULTS Infants allocated to caffeine group showed 83% less risk of getting cognitive impairment (RR 0.16; CI 95% range 0.02 to 1.36), 50% less risk of developing motor deficits (RR 0.50; CI 95% range 0.12 to 1.95) and 24% less risk of developing language problems (RR 0.76; CI 95% range 0.36 to 1.58). However in all the neurodevelopment domains the difference between groups was not statistically significant. Risk of mortality in caffeine group was 9% less over aminophylline group which was statistically non-significant (RR - 0.92; CI 95% range - 0.45 to 1.84; p = 0.81). Physical growth parameters were found to be similar in both the groups. Risk of developing visual abnormality and hearing impairments was also statistically non-significant between the groups. CONCLUSION Caffeine and aminophylline showed similar effects in reducing the rate of mortality and improving the survival without neurodevelopment delays; though the clinical significance of caffeine over aminophylline cannot be undermined.
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Affiliation(s)
- S Khurana
- Department of Physiotherapy, School of Allied Health Sciences, Madhav Nagar, Manipal University, Manipal, Karnataka, India
| | - M Shivakumar
- Department of Pediatrics, Neonatology Unit, Kasturba Medical College, Madhav Nagar, Manipal University, Manipal, Karnataka, India
| | - G V Sujith Kumar Reddy
- Department of Pediatrics, Neonatology Unit, Kasturba Medical College, Madhav Nagar, Manipal University, Manipal, Karnataka, India
| | - P Jayashree
- Department of Physiotherapy, School of Allied Health Sciences, Madhav Nagar, Manipal University, Manipal, Karnataka, India
| | - Y Ramesh Bhat
- Department of Physiotherapy, School of Allied Health Sciences, Madhav Nagar, Manipal University, Manipal, Karnataka, India
| | - L E S Lewis
- Department of Pediatrics, Neonatology Unit, Kasturba Medical College, Madhav Nagar, Manipal University, Manipal, Karnataka, India
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27
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Binder-Heschl C, Crossley K, te Pas A, Polglase G, Blank D, Zahra V, Moxham A, Rodgers K, Hooper S. Haemodynamic effects of prenatal caffeine on the cardiovascular transition in ventilated preterm lambs. PLoS One 2018; 13:e0200572. [PMID: 29995944 PMCID: PMC6040759 DOI: 10.1371/journal.pone.0200572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 06/28/2018] [Indexed: 01/01/2023] Open
Abstract
Background Caffeine is routinely given to preterm infants hours after birth to treat apnea of prematurity. In view of it’s success, earlier administration in the delivery room is being considered, but little is known about how caffeine may effect the cardiovascular changes during the fetal to neonatal transition. Our aim was to determine the effect of prenatal caffeine administration on haemodynamic parameters in ventilated preterm lambs immediately after birth. Methods Catheters (carotid artery and jugular vein) and ultrasonic flow probes (pulmonary artery and carotid artery) were implanted in preterm lambs (~126 ±2 days of gestation; term is 147 days), immediately before delivery by caesarean section. Before the cord was clamped, lambs were intubated and a caffeine (10mg/kg caffeine-base; n = 9) or saline (n = 5) infusion was given intravenously to the ewe and lamb over a 15-minute period. Two minutes after clamping the cord, ventilation commenced with a sustained inflation (35 cm H2O for 30 seconds) followed by ventilation for 30 minutes (target tidal volume of 6-8ml/kg). Results Blood gas parameters and rectal body temperature were not different between the two groups. Changes in pulmonary blood flow (PBF) and carotid blood flow (CBF) did not differ significantly between groups. PBF increased significantly after ventilation onset in both groups (caffeine p = 0.022, saline p <0.001) and remained elevated thereafter. CBF did not increase but decreased after SI in the caffeine group. Blood pressure, heart rate, and peripheral oxygen saturation did not differ between groups at any stage of the study. Conclusion Prenatal caffeine infusion had no significant effect on acute haemodynamic parameters in ventilated preterm lambs during the cardiorespiratory transition.
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Affiliation(s)
- Corinna Binder-Heschl
- Medical University of Graz, Graz, Austria
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Kelly Crossley
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Arjan te Pas
- Department of Pediatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Graeme Polglase
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Douglas Blank
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Newborn Research Centre, The Royal Women’s Hospital, Melbourne, Victoria, Australia
| | - Valerie Zahra
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Alison Moxham
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Karyn Rodgers
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Stuart Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- * E-mail:
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28
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van der Heijden ME, Zoghbi HY. Loss of Atoh1 from neurons regulating hypoxic and hypercapnic chemoresponses causes neonatal respiratory failure in mice. eLife 2018; 7:e38455. [PMID: 29972353 PMCID: PMC6067883 DOI: 10.7554/elife.38455] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 07/01/2018] [Indexed: 12/12/2022] Open
Abstract
Atoh1-null mice die at birth from respiratory failure, but the precise cause has remained elusive. Loss of Atoh1 from various components of the respiratory circuitry (e.g. the retrotrapezoid nucleus (RTN)) has so far produced at most 50% neonatal lethality. To identify other Atoh1-lineage neurons that contribute to postnatal survival, we examined parabrachial complex neurons derived from the rostral rhombic lip (rRL) and found that they are activated during respiratory chemochallenges. Atoh1-deletion from the rRL does not affect survival, but causes apneas and respiratory depression during hypoxia, likely due to loss of projections to the preBötzinger Complex and RTN. Atoh1 thus promotes the development of the neural circuits governing hypoxic (rRL) and hypercapnic (RTN) chemoresponses, and combined loss of Atoh1 from these regions causes fully penetrant neonatal lethality. This work underscores the importance of modulating respiratory rhythms in response to chemosensory information during early postnatal life.
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Affiliation(s)
- Meike E van der Heijden
- Department of NeuroscienceBaylor College of MedicineHoustonUnited States
- Jan and Dan Duncan Neurological Research InstituteTexas Children’s HospitalHoustonUnited States
| | - Huda Y Zoghbi
- Department of NeuroscienceBaylor College of MedicineHoustonUnited States
- Jan and Dan Duncan Neurological Research InstituteTexas Children’s HospitalHoustonUnited States
- Department of Molecular and Human GeneticsBaylor College of MedicineHoustonUnited States
- Department of PediatricsBaylor College of MedicineHoustonUnited States
- Howard Hughes Medical InstituteBaylor College of MedicineHoustonUnited States
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29
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Stojanovska V, Miller SL, Hooper SB, Polglase GR. The Consequences of Preterm Birth and Chorioamnionitis on Brainstem Respiratory Centers: Implications for Neurochemical Development and Altered Functions by Inflammation and Prostaglandins. Front Cell Neurosci 2018; 12:26. [PMID: 29449803 PMCID: PMC5799271 DOI: 10.3389/fncel.2018.00026] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/17/2018] [Indexed: 11/16/2022] Open
Abstract
Preterm birth is a major cause for neonatal morbidity and mortality, and is frequently associated with adverse neurological outcomes. The transition from intrauterine to extrauterine life at birth is particularly challenging for preterm infants. The main physiological driver for extrauterine transition is the establishment of spontaneous breathing. However, preterm infants have difficulty clearing lung liquid, have insufficient surfactant levels, and underdeveloped lungs. Further, preterm infants have an underdeveloped brainstem, resulting in reduced respiratory drive. These factors facilitate the increased requirement for respiratory support. A principal cause of preterm birth is intrauterine infection/inflammation (chorioamnionitis), and infants with chorioamnionitis have an increased risk and severity of neurological damage, but also demonstrate impaired autoresuscitation capacity and prevalent apnoeic episodes. The brainstem contains vital respiratory centers which provide the neural drive for breathing, but the impact of preterm birth and/or chorioamnionitis on this brain region is not well understood. The aim of this review is to provide an overview of the role and function of the brainstem respiratory centers, and to highlight the proposed mechanisms of how preterm birth and chorioamnionitis may affect central respiratory functions.
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Affiliation(s)
- Vanesa Stojanovska
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - Suzanne L Miller
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia.,Department of Obstetrics and Gynaecology, Monash University and Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia.,Department of Obstetrics and Gynaecology, Monash University and Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - Graeme R Polglase
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia.,Department of Obstetrics and Gynaecology, Monash University and Hudson Institute of Medical Research, Melbourne, VIC, Australia
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Cramer SJE, Dekker J, Dankelman J, Pauws SC, Hooper SB, Te Pas AB. Effect of Tactile Stimulation on Termination and Prevention of Apnea of Prematurity: A Systematic Review. Front Pediatr 2018; 6:45. [PMID: 29552548 PMCID: PMC5840648 DOI: 10.3389/fped.2018.00045] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 02/15/2018] [Indexed: 11/16/2022] Open
Abstract
Apnea of prematurity (AOP) is one of the most common diagnoses in preterm infants. Severe and recurrent apneas are associated with cerebral injury and adverse neurodevelopmental outcome. Despite pharmacotherapy and respiratory support to prevent apneas, a proportion of infants continue to have apneas and often need tactile stimulation, mask, and bag ventilation and/or extra oxygen. The duration of the apnea and the concomitant hypoxia and bradycardia depends on the response time of the nurse. We systematically reviewed the literature with the aim of providing an overview of what is known about the effect of manual and mechanical tactile stimulation on AOP. Tactile stimulation, manual or mechanical, has been shown to shorten the duration of apnea, hypoxia, and or bradycardia or even prevent an apnea. Automated stimulation, using closed-loop pulsating or vibrating systems, has been shown to be effective in terminating apneas, but data are scarce. Several studies used continuous mechanical stimulation, with pulsating, vibrating, or oscillating stimuli, to prevent apneas, but the reported effect varied. More studies are needed to confirm whether automated stimulation using a closed loop is more effective than manual stimulation, how and where the automated stimulation should be performed and the potential side effects.
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Affiliation(s)
- Sophie J E Cramer
- Department of Instrumental Affairs, Leiden University Medical Center, Leiden, Netherlands.,Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Janneke Dekker
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Jenny Dankelman
- Department of Biomedical Engineering, Delft University of Technology, Delft, Netherlands
| | - Steffen C Pauws
- Tilburg center for Cognition and Communication (TiCC), Tilburg University, Tilburg, Netherlands
| | - Stuart B Hooper
- The Ritchie Center, MIMR-PHI Institute of Medical Research, Melbourne, VIC, Australia
| | - Arjan B Te Pas
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
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31
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Kraaijenga JV, Hutten GJ, de Waal CG, de Jongh FH, Onland W, van Kaam AH. Classifying Apnea of Prematurity by Transcutaneous Electromyography of the Diaphragm. Neonatology 2018; 113:140-145. [PMID: 29190622 DOI: 10.1159/000484081] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 09/20/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Treatment of apnea is highly dependent on the type of apnea. Chest impedance (CI) has inaccuracies in monitoring respiration, which compromises accurate apnea classification. Electrical activity of the diaphragm measured by transcutaneous electromyography (EMG) is feasible in preterm infants and might improve the accuracy of apnea classification. OBJECTIVES To compare the accuracy of apnea classification based on diaphragmatic EMG (dEMG) and CI tracings in preterm infants. METHODS Fifteen cases of central apnea, 5 of obstructive apnea, and 10 of mixed apnea were selected from recordings containing synchronized continuous tracings of respiratory inductive plethysmography (RIP), airway flow, heart rate (HR), oxygen saturation (SpO2), and breathing activity measured by dEMG and CI. Twenty-two assessors (neonatologists, pediatricians-in-training, and nurses) classified each apnea twice; once based on dEMG, HR, and SpO2 tracings, and once based on CI, HR, and SpO2. The assessors were blinded to the type of respiratory tracing (dEMG or CI) and to the RIP and flow tracings. RESULTS In total 1,320 assessments were performed, and in 71.1% the apnea was classified correctly. Subgroup analysis based on respiratory tracing showed that 74.8% of the dEMG tracings were classified correctly compared to 67.3% of the CI tracings (p < 0.001). This improved apnea classification based on dEMG was present for central (86.7 vs. 80.3%, p < 0.02) and obstructive (56.4 vs. 32.7%, p < 0.001) apnea. The improved apnea classification based on dEMG tracing was independent of the type of assessor. CONCLUSION Transcutaneous dEMG improves the accuracy of apnea classification when compared to CI in preterm infants, making this technique a promising candidate for future monitoring systems.
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Affiliation(s)
- Juliette V Kraaijenga
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
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32
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Medical Devices for Pediatric Apnea Monitoring and Therapy: Past and New Trends. IEEE Rev Biomed Eng 2017; 10:199-212. [DOI: 10.1109/rbme.2017.2757899] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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33
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Atik A, Harding R, De Matteo R, Kondos-Devcic D, Cheong J, Doyle LW, Tolcos M. Caffeine for apnea of prematurity: Effects on the developing brain. Neurotoxicology 2016; 58:94-102. [PMID: 27899304 DOI: 10.1016/j.neuro.2016.11.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 11/20/2016] [Accepted: 11/25/2016] [Indexed: 12/20/2022]
Abstract
Caffeine is a methylxanthine that is widely used to treat apnea of prematurity (AOP). In preterm infants, caffeine reduces the duration of respiratory support, improves survival rates and lowers the incidence of cerebral palsy and cognitive delay. There is, however, little evidence relating to the immediate and long-term effects of caffeine on brain development, especially at the cellular and molecular levels. Experimental data are conflicting, with studies showing that caffeine can have either adverse or benefical effects in the developing brain. The aim of this article is to review current understanding of how caffeine ameliorates AOP, the cellular and molecular mechanisms by which caffeine exerts its effects and the effects of caffeine on brain development. A better knowledge of the effects of caffeine on the developing brain at the cellular and/or molecular level is essential in order to understand the basis for the impact of caffeine on postnatal outcome. The studies reviewed here suggest that while caffeine has respiratory benefits for preterm infants, it may have adverse molecular and cellular effects on the developing brain; indeed a majority of experimental studies suggest that regardless of dose or duration of administration, caffeine leads to detrimental changes within the developing brain. Thus there is an urgent need to assess the impact of caffeine, at a range of doses, on the structure and function of the developing brain in preclinical studies, particularly using clinically relevant animal models. Future studies should focus on determining the maximal dose of caffeine that is safe for the preterm brain.
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Affiliation(s)
- Anzari Atik
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
| | - Richard Harding
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
| | - Robert De Matteo
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
| | - Delphi Kondos-Devcic
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Jeanie Cheong
- Department of Neonatal Services, Royal Women's Hospital, Victorian Infant Brain Studies, Murdoch Children's Research Institute, and Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Lex W Doyle
- Department of Neonatal Services, Royal Women's Hospital, Victorian Infant Brain Studies, Murdoch Children's Research Institute, and Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Mary Tolcos
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia; The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.
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34
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Sloan CD, Gebretsadik T, Rosas-Salazar C, Wu P, Carroll KN, Mitchel E, Anderson LJ, Larkin EK, Hartert TV. Seasonal Timing of Infant Bronchiolitis, Apnea and Sudden Unexplained Infant Death. PLoS One 2016; 11:e0158521. [PMID: 27404386 PMCID: PMC4942135 DOI: 10.1371/journal.pone.0158521] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 06/16/2016] [Indexed: 11/23/2022] Open
Abstract
Rates of Sudden Unexplained Infant Death (SUID), bronchiolitis, and central apnea increase in winter in temperate climates. Though associations between these three conditions are suggested, more work is required to establish if there is a causal pathway linking bronchiolitis to SUID through inducing central apnea. Utilizing a large population-based cohort of infants studied over a 20-year period (n = 834,595, from birth years 1989–2009)), we analyzed ecological associations between timing of SUID cases, bronchiolitis, and apnea healthcare visits. Data were analyzed between 2013 and 2015. We used a Cox Proportional Hazards model to analyze possible interactions between maternal smoking and maternal asthma with infant bronchiolitis on time to SUID. SUID and bronchiolitis both occurred more frequently in winter. An increase in bronchiolitis clinical visits occurred within a few days prior to apnea visits. We found a temporal relationship between infant bronchiolitis and apnea. In contrast, no peak in SUID cases was seen during peaks of bronchiolitis. Among those without any bronchiolitis visits, maternal smoking was associated with an increased risk of SUID: Hazard Ratio (HR) of 2.38 (95% CI: 2.11, 2.67, p-value <0.001). Maternal asthma was associated with an increased risk of SUID among infants with at least one bronchiolitis visit: HR of 2.40 (95% CI: 1.04, 5.54, p-value = 0.04). Consistent trends between bronchiolitis, apnea, and SUID were not established due to small numbers of SUID cases. However, interaction analysis revealed potential differential associations of bronchiolitis and SUID by maternal smoking, maternal asthma status.
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Affiliation(s)
- Chantel D. Sloan
- Department of Health Science, Brigham Young University, Provo, Utah, United States of America
| | - Tebeb Gebretsadik
- Center for Asthma Research, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Christian Rosas-Salazar
- Center for Asthma Research, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Pingsheng Wu
- Center for Asthma Research, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Kecia N. Carroll
- Center for Asthma Research, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Edward Mitchel
- Department of Health Policy,Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Larry J. Anderson
- Department of Pediatrics, Pediatric Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Emma K. Larkin
- Center for Asthma Research, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Tina V. Hartert
- Center for Asthma Research, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- * E-mail:
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Kesavan K, Frank P, Cordero DM, Benharash P, Harper RM. Neuromodulation of Limb Proprioceptive Afferents Decreases Apnea of Prematurity and Accompanying Intermittent Hypoxia and Bradycardia. PLoS One 2016; 11:e0157349. [PMID: 27304988 PMCID: PMC4909267 DOI: 10.1371/journal.pone.0157349] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 05/28/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Apnea of Prematurity (AOP) is common, affecting the majority of infants born at <34 weeks gestational age. Apnea and periodic breathing are accompanied by intermittent hypoxia (IH). Animal and human studies demonstrate that IH exposure contributes to multiple pathologies, including retinopathy of prematurity (ROP), injury to sympathetic ganglia regulating cardiovascular action, impaired pancreatic islet cell and bone development, cerebellar injury, and neurodevelopmental disabilities. Current standard of care for AOP/IH includes prone positioning, positive pressure ventilation, and methylxanthine therapy; these interventions are inadequate, and not optimal for early development. OBJECTIVE The objective is to support breathing in premature infants by using a simple, non-invasive vibratory device placed over limb proprioceptor fibers, an intervention using the principle that limb movements trigger reflexive facilitation of breathing. METHODS Premature infants (23-34 wks gestational age), with clinical evidence of AOP/IH episodes were enrolled 1 week after birth. Caffeine treatment was not a reason for exclusion. Small vibration devices were placed on one hand and one foot and activated in 6 hour ON/OFF sequences for a total of 24 hours. Heart rate, respiratory rate, oxygen saturation (SpO2), and breathing pauses were continuously collected. RESULTS Fewer respiratory pauses occurred during vibration periods, relative to baseline (p<0.005). Significantly fewer SpO2 declines occurred with vibration (p<0.05), relative to control periods. Significantly fewer bradycardic events occurred during vibration periods, relative to no vibration periods (p<0.05). CONCLUSIONS In premature neonates, limb proprioceptive stimulation, simulating limb movement, reduces breathing pauses and IH episodes, and lowers the number of bradycardic events that accompany aberrant breathing episodes. This low-cost neuromodulatory procedure has the potential to provide a non-invasive intervention to reduce apnea, bradycardia and intermittent hypoxia in premature neonates. TRIAL REGISTRATION ClinicalTrials.gov NCT02641249.
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Affiliation(s)
- Kalpashri Kesavan
- Pediatrics, University of California Los Angeles, Los Angeles, California, United States of America
- * E-mail:
| | - Paul Frank
- Cardiothoracic Surgery, University of California Los Angeles, Los Angeles, California, United States of America
| | - Daniella M. Cordero
- Pediatrics, University of California Los Angeles, Los Angeles, California, United States of America
| | - Peyman Benharash
- Surgery, Harbor-UCLA, Los Angeles, California, United States of America
| | - Ronald M. Harper
- Neurobiology, University of California Los Angeles, Los Angeles, California, United States of America
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Oñatibia-Astibia A, Martínez-Pinilla E, Franco R. The potential of methylxanthine-based therapies in pediatric respiratory tract diseases. Respir Med 2016; 112:1-9. [PMID: 26880379 DOI: 10.1016/j.rmed.2016.01.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 10/07/2015] [Accepted: 01/28/2016] [Indexed: 02/03/2023]
Abstract
Caffeine, theophylline and theobromine are the most known methylxanthines as they are present in coffee, tea and/or chocolate. In the last decades, a huge experimental effort has been devoted to get insight into the variety of actions that these compounds exert in humans. From such knowledge it is known that methylxanthines have a great potential in prevention, therapy and/or management of a variety of diseases. The benefits of methylxanthine-based therapies in the apnea of prematurity and their translational potential in pediatric affections of the respiratory tract are here presented.
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Affiliation(s)
| | - Eva Martínez-Pinilla
- Neuroscience Department, Center for Applied Medical Research (CIMA), University of Navarra, 31008 Pamplona, Spain.
| | - Rafael Franco
- Molecular Neurobiology Laboratory, Department of Biochemistry and Molecular Biology, Faculty of Biology, University of Barcelona, 08028 Barcelona, Spain; CIBERNED, Centro de Investigación en Red, Enfermedades Neurodegenerativas, Instituto de Salud Carlos III, 28049 Madrid, Spain; Institute of Biomedicine of the University of Barcelona, IBUB, 08028, Barcelona, Spain.
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Ten Hove CH, Vliegenthart RJ, Te Pas AB, Brouwer E, Rijken M, van Wassenaer-Leemhuis AG, van Kaam AH, Onland W. Long-Term Neurodevelopmental Outcome after Doxapram for Apnea of Prematurity. Neonatology 2016; 110:21-6. [PMID: 26967910 DOI: 10.1159/000444006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 01/14/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Doxapram has been advocated as a treatment for persistent apnea of prematurity (AOP). OBJECTIVE To evaluate the effect of doxapram on long-term neurodevelopmental outcome in preterm infants as its safety still needs to be established. METHODS From a retrospective cohort of preterm infants with a gestational age (GA) <30 weeks and/or a birth weight <1,250 g, born between 2000 and 2010, infants treated with doxapram (n = 142) and a nontreated control group were selected (n = 284). Patient characteristics and clinical and neurodevelopmental outcome data at 24 months' corrected age were collected. Neurodevelopmental delay (ND) was defined as having a Mental or Psychomotor Developmental Index (MDI/PDI) <-1 standard deviation (SD), cerebral palsy, or a hearing or visual impairment. Odds ratios (OR) were calculated using multiple logistic regression analyses adjusting for potential confounders. RESULTS Infants treated with doxapram had a lower GA compared to controls. The number of infants with a MDI or PDI <-1 SD was not different between the groups. The risk of the combined outcome death or ND was significantly lower in the doxapram group after adjusting for confounding factors (OR = 0.54, 95% CI: 0.37, 0.78). Doxapram-treated infants had a higher risk of bronchopulmonary dysplasia and patent ductus arteriosus, but a lower risk of spontaneous intestinal perforation. All other morbidities were not different between the groups. CONCLUSIONS This study suggests that doxapram is not associated with an increased risk of ND. These findings need to be confirmed or refuted by a large, well-designed, placebo-controlled randomized trial.
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Affiliation(s)
- Christine H Ten Hove
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
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Kraaijenga JV, Hutten GJ, de Jongh FH, van Kaam AH. Transcutaneous electromyography of the diaphragm: A cardio-respiratory monitor for preterm infants. Pediatr Pulmonol 2015; 50:889-95. [PMID: 25327880 DOI: 10.1002/ppul.23116] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 08/24/2014] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Chest impedance (CI) is the current standard for cardio-respiratory monitoring in preterm infants but fails to provide direct and quantitative information on diaphragmatic activity. Transcutaneous electromyography (dEMG) is able to measure diaphragmatic activity, but its feasibility and repeatability to monitor respiratory rate (RR) and heart rate (HR) in preterm infants needs to be established. METHODS RR and HR were measured simultaneously by dEMG and CI for 1-hour on day 1, 3, and 7 of life in 31 preterm infants (gestational age 29.6 ± 1.8 weeks; birth weight 1380 ± 350 g) on non-invasive respiratory support. Six fixed 1-minute time intervals were selected from each 1-hour recording and both RR and HR were calculated using all intervals or only those with stable dEMG and CI recordings. RESULTS dEMG was well tolerated and signal quality was good. Both RR and HR measured by dEMG and CI were significantly correlated (RR: r = 0.85, HR: r = 0.98) and showed good agreement by the Bland-Altman plot (mean difference (limits of agreement): RR: -2.3 (-17.3 to 12.7) breaths/min and HR: -0.3 (-5.3 to 4.7) beats/min. When analyzing only stable recordings, the correlation (r = 0.92) and agreement (-1.8 (-12.3 to 8.7) breaths/min) for RR improved. Subgroup analyses for postnatal age, gestational age, and mode of support showed similar results suggesting good repeatability of dEMG. CONCLUSION This study shows that monitoring RR and HR with transcutaneous dEMG is feasible and repeatable in preterm infants.
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Affiliation(s)
- Juliette V Kraaijenga
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Gerard J Hutten
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Frans H de Jongh
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Anton H van Kaam
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
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Mohammed S, Nour I, Shabaan AE, Shouman B, Abdel-Hady H, Nasef N. High versus low-dose caffeine for apnea of prematurity: a randomized controlled trial. Eur J Pediatr 2015; 174:949-56. [PMID: 25644724 DOI: 10.1007/s00431-015-2494-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 01/09/2015] [Accepted: 01/16/2015] [Indexed: 01/10/2023]
Abstract
UNLABELLED The optimum caffeine dose in preterm infants has not been well investigated. We aimed to compare the efficacy and safety of high versus low-dose caffeine citrate on apnea of prematurity (AOP) and successful extubation of preterm infants from mechanical ventilation. We compared high-dose (loading 40 mg/kg/day and maintenance of 20 mg/kg/day) versus low-dose (loading 20 mg/kg/day and maintenance of 10 mg/kg/day) caffeine citrate in preterm infants <32 weeks gestation, presented with AOP within the first 10 days of life. A total of 120 neonates (60 in each group) were enrolled. High-dose caffeine was associated with a significant reduction in extubation failure in mechanically ventilated preterm infants (p<0.05), the frequency of apnea (p<0.001), and days of documented apnea (p<0.001). High-dose caffeine was associated with significant increase in episodes of tachycardia (p<0.05) without a significant impact on physician decision to withhold caffeine. CONCLUSION The use of higher, than current standard, dose of caffeine may decrease the chance of extubation failure in mechanically ventilated preterm infants and frequency of AOP without significant side effects. WHAT IS KNOWN • Caffeine therapy for treatment of apnea of prematurity has been well established over the past few years. The optimal loading and maintenance dose of caffeine in preterm infants is not well-studied. What is New: • This double blind randomized controlled trial demonstrated that using a higher, than current standard, loading and maintenance doses of caffeine for treatment of apnea in preterm infants is well tolerated and significantly decrease the frequency of apnea.
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Affiliation(s)
- Sameh Mohammed
- Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt,
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Kraaijenga JV, Hutten GJ, de Jongh FH, van Kaam AH. The Effect of Caffeine on Diaphragmatic Activity and Tidal Volume in Preterm Infants. J Pediatr 2015; 167:70-5. [PMID: 25982138 DOI: 10.1016/j.jpeds.2015.04.040] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 03/18/2015] [Accepted: 04/14/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine the effect of caffeine on diaphragmatic activity, tidal volume (Vt), and end-expiratory lung volume (EELV) in preterm infants. STUDY DESIGN Using transcutaneous electromyography of the diaphragm (dEMG), we measured diaphragmatic activity from 30 minutes before (baseline) to 3 hours after administration of an intravenous caffeine-base loading dose in 30 spontaneously breathing preterm infants (mean gestational age, 29.1 ± 1.3 weeks), most of whom were on noninvasive respiratory support. Diaphragmatic activity was expressed as the percentage change in dEMG amplitude, area under the curve, respiratory rate, and inspiratory and expiratory times. Using respiratory inductive plethysmography, we measured changes in Vt and EELV from baseline. These outcome variables were calculated at 8 fixed time points after caffeine administration (5, 15, 30, 60, 90, 120, 150, and 180 minutes) and compared with baseline. RESULTS Caffeine administration resulted in rapid (within 5 minutes) increases in dEMG amplitude (median, 43%; IQR, 24%-63%; P < .001) and area under the curve (median, 28%; IQR, 14%-48%; P < .001). Vt also increased by a median of 30% (IQR, 7%-48%), and this change was significantly correlated with the change in dEMG amplitude (r = 0.67; P < .001). These effects were relatively stable until 120 minutes after caffeine administration. Caffeine did not consistently impact EELV, respiratory rate, or inspiratory and expiratory times. CONCLUSION Caffeine treatment results in a rapid and sustained increase in diaphragmatic activity and Vt in preterm infants.
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Affiliation(s)
- Juliette V Kraaijenga
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
| | - Gerard J Hutten
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Frans H de Jongh
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Anton H van Kaam
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
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Petrova A, Mehta R. Alteration in regional tissue oxygenation of preterm infants during placement in the semi-upright seating position. Sci Rep 2015; 5:8343. [PMID: 25661986 PMCID: PMC4321184 DOI: 10.1038/srep08343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 01/15/2015] [Indexed: 01/30/2023] Open
Abstract
We investigated whether the cerebral (rSO2-C %) and renal (rSO2-R %) tissue oxygenation of preterm infants is altered by repositioning from the supine to semi-upright position for pre-discharge car seat testing. Near-infrared spectroscopy was used to measure rSO2-C and rSO2-R, which were recorded simultaneously with vital signs in 15 preterm infants for 30 minutes in supine, 60 minutes in the semi-upright (at 45 degrees in a car seat), and 30 minutes in the post-semi-upright (supine) position. Changes in rSO2-C and SO2-R were mostly within 1 Standard Deviation (SD) of baseline mean levels in the supine position. Decrease in rSO2-C and rSO2-R (more than 1SD below baseline mean) was recorded in 26.7% and 6.6% of infants respectively, which persisted even after adjustment for variation in heart and respiratory rate, and pulse oximeter measured oxygen saturation (P, 0.0001). Re-positioning the infants from the car seat to supine position was associated with normalization of the rSO2-C. Alteration in rSO2-C and rSO2-R in a car seat was independent from the gestational and post-conception age, weight and presence of anemia. We concluded that approximately one-third of preterm infants show minor reduction of cerebral tissue oxygenation in the semi-upright (car seat) position.
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Affiliation(s)
- Anna Petrova
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901
| | - Rajeev Mehta
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901
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Jeong K, Kim HS, Song ES, Choi YY. Comparison between Caffeine and Theophylline Therapy for Apnea of Prematurity. NEONATAL MEDICINE 2015. [DOI: 10.5385/nm.2015.22.1.14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Kumi Jeong
- Department of Pediatrics, Chonnam National University Hospital, Gwangju, Korea
| | - Ho Sung Kim
- Department of Pediatrics, Chonnam National University Hospital, Gwangju, Korea
| | - Eun Song Song
- Department of Pediatrics, Chonnam National University Hospital, Gwangju, Korea
| | - Young Youn Choi
- Department of Pediatrics, Chonnam National University Hospital, Gwangju, Korea
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Mohr MA, Vergales BD, Lee H, Clark MT, Lake DE, Mennen AC, Kattwinkel J, Sinkin RA, Moorman JR, Fairchild KD, Delos JB. Very long apnea events in preterm infants. J Appl Physiol (1985) 2014; 118:558-68. [PMID: 25549762 DOI: 10.1152/japplphysiol.00144.2014] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Apnea is nearly universal among very low birth weight (VLBW) infants, and the associated bradycardia and desaturation may have detrimental consequences. We describe here very long (>60 s) central apnea events (VLAs) with bradycardia and desaturation, discovered using a computerized detection system applied to our database of over 100 infant years of electronic signals. Eighty-six VLAs occurred in 29 out of 335 VLBW infants. Eighteen of the 29 infants had a clinical event or condition possibly related to the VLA. Most VLAs occurred while infants were on nasal continuous positive airway pressure, supplemental oxygen, and caffeine. Apnea alarms on the bedside monitor activated in 66% of events, on average 28 s after cessation of breathing. Bradycardia alarms activated late, on average 64 s after cessation of breathing. Before VLAs oxygen saturation was unusually high, and during VLAs oxygen saturation and heart rate fell unusually slowly. We give measures of the relative severity of VLAs and theoretical calculations that describe the rate of decrease of oxygen saturation. A clinical conclusion is that very long apnea (VLA) events with bradycardia and desaturation are not rare. Apnea alarms failed to activate for about one-third of VLAs. It appears that neonatal intensive care unit (NICU) personnel respond quickly to bradycardia alarms but not consistently to apnea alarms. We speculate that more reliable apnea detection systems would improve patient safety in the NICU. A physiological conclusion is that the slow decrease of oxygen saturation is consistent with a physiological model based on assumed high values of initial oxygen saturation.
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Affiliation(s)
- Mary A Mohr
- Department of Physics, College of William and Mary, Williamsburg, Virginia;
| | - Brooke D Vergales
- Department of Pediatrics (Neonatology), University of Virginia, Charlottesville, Virginia
| | - Hoshik Lee
- Department of Physics, College of William and Mary, Williamsburg, Virginia; Samsung Advanced Institute of Technology, Suwon, South Korea
| | - Matthew T Clark
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia
| | - Douglas E Lake
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia; Department of Statistics, University of Virginia, Charlottesville, Virginia
| | - Anne C Mennen
- Department of Physics, College of William and Mary, Williamsburg, Virginia
| | - John Kattwinkel
- Department of Pediatrics (Neonatology), University of Virginia, Charlottesville, Virginia
| | - Robert A Sinkin
- Department of Pediatrics (Neonatology), University of Virginia, Charlottesville, Virginia
| | - J Randall Moorman
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia; Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia; and Department of Molecular Physiology, University of Virginia, Charlottesville, Virginia
| | - Karen D Fairchild
- Department of Pediatrics (Neonatology), University of Virginia, Charlottesville, Virginia
| | - John B Delos
- Department of Physics, College of William and Mary, Williamsburg, Virginia
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Ulanovsky I, Haleluya NS, Blazer S, Weissman A. The effects of caffeine on heart rate variability in newborns with apnea of prematurity. J Perinatol 2014; 34:620-3. [PMID: 24722649 DOI: 10.1038/jp.2014.60] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Revised: 02/25/2014] [Accepted: 03/03/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Apnea of prematurity is a common complication in premature newborns and caffeine is a widespread medication used to treat this complication. Caffeine may have adverse effects on the cardiovascular and central nervous system, yet its effects on the autonomic nervous system modulation of heart rate have not been studied in premature newborns, which was the objective of our study. STUDY DESIGN We prospectively studied 21 premature newborns who were treated with caffeine. We analyzed heart rate variability by power spectral density and by dynamic nonlinear analyses methods. RESULT There were no changes in heart rate, blood pressure or the autonomic nervous system tone following administration of caffeine, nor were the nonlinear dynamical properties of the system altered by caffeine. CONCLUSION Caffeine does not have detrimental effects on heart rate variability, heart rate or blood pressure in conventional doses given to premature newborns.
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Affiliation(s)
- I Ulanovsky
- Departments of Neonatology, Rambam Health Care Campus, Technion-Israel Institute of Technology, Haifa, Israel
| | - N S Haleluya
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - S Blazer
- 1] Departments of Neonatology, Rambam Health Care Campus, Technion-Israel Institute of Technology, Haifa, Israel [2] Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - A Weissman
- 1] Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel [2] Department of Obstetrics and Gynecology, Rambam Health Care Campus, Technion-Israel Institute of Technology, Haifa, Israel
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Atik A, Cheong J, Harding R, Rees S, De Matteo R, Tolcos M. Impact of daily high-dose caffeine exposure on developing white matter of the immature ovine brain. Pediatr Res 2014; 76:54-63. [PMID: 24739937 DOI: 10.1038/pr.2014.55] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 01/16/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Caffeine is widely used to treat apnea of prematurity, but the standard dosing regimen is not always sufficient to prevent apnea. Before higher doses of caffeine can be used, their effects on the immature brain need to be carefully evaluated. Our aim was to determine the impact of daily high-dose caffeine administration on the developing white matter of the immature ovine brain. METHODS High-dose caffeine (25 mg/kg caffeine base loading dose; 20 mg/kg daily maintenance dose; n = 9) or saline (n = 8) were administered to pregnant sheep from 0.7 to 0.8 of term, equivalent to approximately 27-34 wk in humans. At 0.8 of term, the white and gray matter were assessed histologically and immunohistochemically. RESULTS Daily caffeine administration led to peak caffeine concentration of 32 mg/l in fetal plasma at 1 h, followed by a gradual decline, with no effects on mean arterial pressure and heart rate. Initial caffeine exposure led to transient, mild alkalosis in the fetus but did not alter oxygenation. At necropsy, there was no effect of daily high-dose caffeine on brain weight, oligodendrocyte density, myelination, axonal integrity, microgliosis, astrogliosis, apoptosis, or neuronal density. CONCLUSION Daily high-dose caffeine administration does not appear to adversely affect the developing white matter at the microstructural level.
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Affiliation(s)
- Anzari Atik
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
| | - Jeanie Cheong
- 1] Department of Neonatal Services, Royal Women's Hospital, Victorian Infant Brain Studies, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia [2] Department of Obstetrics and Gynecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Richard Harding
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
| | - Sandra Rees
- Department of Anatomy and Neuroscience, University of Melbourne, Melbourne, Victoria, Australia
| | - Robert De Matteo
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
| | - Mary Tolcos
- The Ritchie Centre, MIMR-PHI Institute of Medical Research and Monash University, Clayton, Victoria, Australia
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van Zanten HA, Tan RNGB, Thio M, de Man-van Ginkel JM, van Zwet EW, Lopriore E, te Pas AB. The risk for hyperoxaemia after apnoea, bradycardia and hypoxaemia in preterm infants. Arch Dis Child Fetal Neonatal Ed 2014; 99:F269-73. [PMID: 24668832 DOI: 10.1136/archdischild-2013-305745] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the occurrence and duration of oxygen saturation (SpO₂) ≥95%, after extra oxygen for apnoea, bradycardia, cyanosis (ABC), and the relation with the duration of bradycardia and/or SpO₂ ≤80%. METHODS All preterm infants <32 weeks' gestation supported with nasal continuous positive airway pressure (nCPAP) admitted to our centre were eligible for the study. We retrospectively identified all episodes of ABCs. In ABCs where oxygen supply was increased, duration and severity of bradycardia (<80 bpm), SpO₂ ≤80%, SpO₂ ≥95% and their correlation were investigated. RESULTS In 56 infants, 257 ABCs occurred where oxygen supply was increased. SpO₂ ≥95% occurred after 79% (202/257) of the ABCs, duration of extra oxygen supply was longer in ABCs with SpO₂ ≥95% than without SpO₂ ≥95% (median (IQR) 20 (8-80) vs 2 (2-3) min; p<0.001)). The duration of SpO₂ ≥95% was longer than bradycardia and SpO₂ ≤80% (median (IQR) 13 (4-30) vs 1 (1-1) vs 2 (1-2) min; p<0.001). SpO₂ ≥95% lasted longer when infants were in ambient air than when oxygen was given before the ABC occurred (median (IQR)15 (5-38) min vs 6 (3-24) min; p<0.01). CONCLUSIONS In preterm infants supported with nCPAP in the neonatal intensive care unit (NICU), SpO₂ ≥95% frequently occurred when oxygen was increased for ABCs and lasted longer than the bradycardia and SpO₂ ≤80%.
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Chintamaneni K, Bruder ED, Raff H. Programming of the hypothalamic-pituitary-adrenal axis by neonatal intermittent hypoxia: effects on adult male ACTH and corticosterone responses are stress specific. Endocrinology 2014; 155:1763-70. [PMID: 24564395 DOI: 10.1210/en.2013-1736] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Intermittent hypoxia (IH) is an animal model of apnea-induced hypoxia, a common stressor in the premature neonate. Neonatal stressors may have long-term programming effects in the adult. We hypothesized that neonatal exposure to IH leads to significant changes in basal and stress-induced hypothalamic-pituitary-adrenal (HPA) axis function in the adult male rat. Rat pups were exposed to normoxia (control) or 6 approximately 30-second cycles of IH (5% or 10% inspired O₂) daily on postnatal days 2-6. At approximately 100 days of age, we assessed the diurnal rhythm of plasma corticosterone and stress-induced plasma ACTH and corticosterone responses, as well as mRNA expression of pertinent genes within the HPA axis. Basal diurnal rhythm of plasma corticosterone concentrations in the adult rat were not affected by prior exposure to neonatal IH. Adults exposed to 10% IH as neonates exhibited an augmented peak ACTH response and a prolonged corticosterone response to restraint stress; however, HPA axis responses to insulin-induced hypoglycemia were not augmented in adults exposed to neonatal IH. Pituitary Pomc, Crhr1, Nr3c1, Nr3c2, Avpr1b, and Hif1a mRNA expression was decreased in adults exposed to neonatal 10% IH. Expression of pertinent hypothalamic and adrenal mRNAs was not affected by neonatal IH. We conclude that exposure to neonatal 10% IH programs the adult HPA axis to hyperrespond to acute stimuli in a stressor-specific manner.
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Affiliation(s)
- Kathan Chintamaneni
- Endocrine Research Laboratory (K.C., E.D.B., H.R.), Aurora St Luke's Medical Center, Aurora Research Institute, Milwaukee, Wisconsin 53215; and Departments of Medicine, Surgery, and Physiology (H.R.), Medical College of Wisconsin, Milwaukee, Wisconsin 53226
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Kilicdag H, Daglioglu YK, Erdogan S, Zorludemir S. Effects of caffeine on neuronal apoptosis in neonatal hypoxic-ischemic brain injury. J Matern Fetal Neonatal Med 2014; 27:1470-5. [PMID: 24392823 DOI: 10.3109/14767058.2013.878694] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Hypoxia-ischemia (HI) in rat pups leads to strong activation of apoptosis, and apoptosis contributes significantly to cerebral damage in the perinatal period. Caffeine displays a broad array of actions on the brain. The aim of this study was to investigate the effects of caffeine on neuronal apoptosis in a hypoxic-ischemic neonatal model. METHODS Twenty-four seven-day-old Wistar rat pups were subjected to right common carotid artery ligation and hypoxia for 2 h. Sham group (n = 8) had a median neck incision, but the rats were not subjected to ligation or hypoxia. The pups were treated with 20 mg/kg/day caffeine citrate (n = 8) or saline (n = 8) immediately before HI and at 0, 24, 48 and 72 h post-hypoxia. Neuronal apoptosis was evaluated by terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) and caspase-3 in the hippocampus and parietal cortex of both hemispheres. RESULTS The numbers of apoptotic cells in the hippocampus and parietal cortex were significantly higher in the saline group than they were in the sham group (p < 0.0001). The number of apoptotic cells in the hippocampus (p < 0.0001) and parietal cortex (p < 0.0001, TUNEL and p = 0.001, caspase-3) were higher in the caffeine-treated group than they were in the sham group, but the number of apoptotic cells decreased significantly in the caffeine-treated group compared with the saline group in the hippocampus (p < 0.0001, TUNEL and p = 0.001, caspase-3) and parietal cortex (p = 0.001, TUNEL and p = 0.002, caspase-3). CONCLUSIONS We show that caffeine administration in hypoxic-ischemic brain injury reduces neuronal apoptosis in the developing brain. We suggest that caffeine may be effective in reducing brain injury.
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Affiliation(s)
- Hasan Kilicdag
- Division of Neonatology, Department of Paediatrics, Acıbadem Hospital , Adana , Turkey
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Dergacheva O, Weigand LA, Dyavanapalli J, Mares J, Wang X, Mendelowitz D. Function and modulation of premotor brainstem parasympathetic cardiac neurons that control heart rate by hypoxia-, sleep-, and sleep-related diseases including obstructive sleep apnea. PROGRESS IN BRAIN RESEARCH 2014; 212:39-58. [PMID: 25194192 DOI: 10.1016/b978-0-444-63488-7.00003-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Parasympathetic cardiac vagal neurons (CVNs) in the brainstem dominate the control of heart rate. Previous work has determined that these neurons are inherently silent, and their activity is largely determined by synaptic inputs to CVNs that include four major types of synapses that release glutamate, GABA, glycine, or serotonin. Whereas prior reviews have focused on glutamatergic, GABAergic and glycinergic pathways, and the receptors in CVNs activated by these neurotransmitters, this review focuses on the alterations in CVN activity with hypoxia-, sleep-, and sleep-related cardiovascular diseases including obstructive sleep apnea.
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Affiliation(s)
- Olga Dergacheva
- Department of Pharmacology and Physiology, School of Medicine, George Washington University, Washington, DC, USA
| | - Letitia A Weigand
- Department of Pharmacology and Physiology, School of Medicine, George Washington University, Washington, DC, USA
| | - Jhansi Dyavanapalli
- Department of Pharmacology and Physiology, School of Medicine, George Washington University, Washington, DC, USA
| | - Jacquelyn Mares
- Department of Pharmacology and Physiology, School of Medicine, George Washington University, Washington, DC, USA
| | - Xin Wang
- Department of Pharmacology and Physiology, School of Medicine, George Washington University, Washington, DC, USA
| | - David Mendelowitz
- Department of Pharmacology and Physiology, School of Medicine, George Washington University, Washington, DC, USA.
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Fehrholz M, Hütten M, Kramer BW, Speer CP, Kunzmann S. Amplification of steroid-mediated SP-B expression by physiological levels of caffeine. Am J Physiol Lung Cell Mol Physiol 2013; 306:L101-9. [PMID: 24163141 DOI: 10.1152/ajplung.00257.2013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Factors positively influencing surfactant homeostasis in general and surfactant protein B (SP-B) expression in particular are considered of clinical importance regarding an improvement of lung function in preterm infants. The objective of this study was to identify effects of physiological levels of caffeine on glucocorticoid-mediated SP-B expression in vitro and in vivo. Levels of SP-B and pepsinogen C were quantified by quantitative real-time RT-PCR or immunoblotting in NCI-H441 cells daily exposed to caffeine and/or dexamethasone (DEX). In vivo, SP-B expression was analyzed in bronchoalveolar lavage (BAL) of preterm sheep exposed to antenatal DEX and/or postnatal caffeine. If DEX and caffeine were continuously present, SP-B mRNA and protein levels were increased for up to 6 days after induction (P < 0.05). Additionally, caffeine enhanced SP-B mRNA expression in DEX-pretreated cells (P < 0.05). Moreover, caffeine amplified DEX-induced pepsinogen C mRNA expression (P < 0.05). After short-term treatment with caffeine in vivo, only slightly higher SP-B levels could be detected in BAL of preterm sheep following antenatal DEX, combined with an increase of arterial oxygen partial pressure (P < 0.01). Our data demonstrated that the continuous presence of caffeine in vitro is able to amplify DEX-mediated SP-B expression. In contrast, short-term improvement of lung function in vivo is likely to be independent of altered SP-B transcription and translation. An impact of caffeine on release of surfactant reservoirs from lamellar bodies could, however, quickly affect SP-B content in BAL, which has to be further investigated. Our findings indicate that caffeine is able to amplify main effects of glucocorticoids that result from changes in surfactant production, maturation, and release.
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Affiliation(s)
- Markus Fehrholz
- Univ. Children's Hospital, Univ. of Wuerzburg, Josef-Schneider-Str. 2, D-97080 Wuerzburg, Germany.
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