Caffeine citrate for apnea of prematurity-One dose does not fit all a prospective study

Effect of early preventive use of caffeine citrate on prevention together with treatment of BPD within premature infants and its influence on inflammatory factors

OBJECTIVE

To explore caffeine citrate prophylactic and therapeutic influences upon broncho-pulmonary dysplasia (BPD) within premature infants and its influence on inflammatory factors.

METHODS

A total of 128 premature infants from January 2021 to June 2022 were investigated, segregated within control group and observation group through randomized number table protocol, having 64 cases per group.

RESULTS

Effective rate of observation group was elevated in comparison to control group (95.31% versus 84.38%, P < 0.05). The number of apnea of prematurity (AOP) in observation group was reduced in comparison to control group, while duration of auxiliary ventilation together with hospitalization days were reduced in comparison to control group (P < 0.05). Post-therapy, matrix metalloproteinase-9 (MMP-9), tumor necrosis factor (TNF-α) and Toll-like receptor-4 (TLR-4) were downregulated within observation group, while scorings for psychomotor development index (PDI) and mental development index (MDI) in observation group were elevated in comparison to control group (P < 0.05). Weight-gain rate and growth rate of body length within observation group was elevated in comparison to control group (P < 0.05). Post-therapy, work of breathing (WOB) and airway resistance (Raw) within observation group were lower compared to control group, while respiratory system compliance (Crs) was elevated in comparison to control group (P < 0.05). Occurrences of broncho-pulmonary dysplasia (BPD) within observation group was reduced in comparison to control group (P < 0.05).

CONCLUSION

Early prophylactic use of caffeine citrate can effectively reduce the incidence of BPD in premature infants.

Caffeine and cerebral palsy: A systematic review of randomized controlled trials and cohort studies

OBJECTIVE

To systematically review the effects of caffeine on the development of cerebral palsy (CP).

DESIGN

Systematic review.

SETTING

A search of five databases was performed to identify randomized controlled trials (RCT) or cohort studies published through May 2022. Studies conducted on newborns at risk of developing CP upon receiving caffeine in the first days of life were included as well. Two independent researchers assessed the screening, data extraction, and methodological quality assessment.

MAIN OUTCOME MEASURES

Percentage of children with CP.

RESULTS

Four studies met our inclusion criteria. The only RCT found a decreased risk (approximately 40 %) of developing CP with 20 mg/kg caffeine citrate (OR 0.59, 95 % CI 0.39, 0.89). In addition, when comparing the period over which caffeine citrate was administered, one retrospective cohort study reported that infants who received caffeine up to the second day of life were also less likely to develop CP. Some methodological issues should be highlighted: in the RCT, the differences between the groups with respect to loss to follow-up were not explored. Similarly, intention-to-treat analyses were not performed. Most cohort studies have not adequately identified the primary confounding factors.

CONCLUSIONS

Caffeine could be an important intervention in preventing CP. However, few studies have assessed the effects of caffeine on the risk of CP development. Due to methodological differences, no recommendation regarding its use can be safely made. The findings suggest a positive effect of caffeine citrate in the early stages of life with approximately 20 mg/kg of weight; however, well-designed RCTs with adequate sample size and power, randomization process, outcome measurement, and data analysis are still required.

[Recent research on gene polymorphisms related to caffeine therapy in preterm infants with apnea of prematurity]

Apnea of prematurity (AOP) is one of the common diseases in preterm infants. The main cause of AOP is immature development of the respiratory control center. If AOP is not treated timely and effectively, it will lead to respiratory failure, hypoxic brain injury, and even death in severe cases. Caffeine is the first choice for the treatment of AOP, but its effectiveness varies in preterm infants. With the deepening of AOP research, more and more genetic factors have been confirmed to play important roles in the pathogenesis and treatment of AOP; in particular, the influence of single nucleotide polymorphism on the efficacy of caffeine has become a research hotspot in recent years. This article reviews the gene polymorphisms that affect the efficacy of caffeine, in order to provide a reference for individualized caffeine therapy. Citation.