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Irimu G, Okwaro F, Coleman J, Waiyego M, Murila F, Chomba D, Parsimei M, Shitote C, Ochieng R, Shah J, Ogero M, Ginsburg AS, Ansermino JM, Macharia W. Developing and testing a clinical care bundle incorporating caffeine citrate to manage apnoea of prematurity in a resource-constrained setting: a mixed methods clinical feasibility study protocol. Implement Sci Commun 2023; 4:80. [PMID: 37461120 PMCID: PMC10351121 DOI: 10.1186/s43058-023-00455-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/15/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Apnoea of prematurity (AOP) is a common condition among preterm infants. Methylxanthines, such as caffeine and aminophylline/theophylline, can help prevent and treat AOP. Due to its physiological benefits and fewer side effects, caffeine citrate is recommended for the prevention and treatment of AOP. However, caffeine citrate is not available in most resource-constrained settings (RCS) due to its high cost. Challenges in RCS using caffeine citrate to prevent AOP include identifying eligible preterm infants where gestational age is not always known and the capability for continuous monitoring of vital signs to readily identify apnoea. We aim to develop an evidence-based care bundle that includes caffeine citrate to prevent and manage AOP in tertiary healthcare facilities in Kenya. METHODS This protocol details a prospective mixed-methods clinical feasibility study on using caffeine citrate to manage apnoea of prematurity in a single facility tertiary-care newborn unit (NBU) in Nairobi, Kenya. This study will include a 4-month formative research phase followed by the development of an AOP clinical-care-bundle prototype over 2 months. In the subsequent 4 months, implementation and improvement of the clinical-care-bundle prototype will be undertaken. The baseline data will provide contextualised insights on care practices within the NBU that will inform the development of a context-sensitive AOP clinical-care-bundle prototype. The clinical care bundle will be tested and refined further during an implementation phase of the quality improvement initiative using a PDSA framework underpinned by quantitative and qualitative clinical audits and stakeholders' engagement. The quantitative component will include all neonates born at gestation age < 34 weeks and any neonate prescribed aminophylline or caffeine citrate admitted to the NBU during the study period. DISCUSSION There is a need to develop evidence-based and context-sensitive clinical practice guidelines to standardise and improve the management of AOP in RCS. Concerns requiring resolution in implementing such guidelines include diagnosis of apnoea, optimal timing, dosing and administration of caffeine citrate, standardisation of monitoring devices and alarm limits, and discharge protocols. We aim to provide a feasible standardised clinical care bundle for managing AOP in low and middle-income settings.
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Affiliation(s)
- Grace Irimu
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya.
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, P.O. Box 43640, Nairobi, 00100, Kenya.
| | | | - Jesse Coleman
- The University of British Columbia, Vancouver, Canada
| | - Mary Waiyego
- Division of Paediatrics, Kenyatta National Hospital, Nairobi, Kenya
| | - Florence Murila
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Dorothy Chomba
- Department of Paediatrics, Aga Khan University, Nairobi, Kenya
| | | | - Cynthia Shitote
- Department of Paediatrics, Aga Khan University, Nairobi, Kenya
| | | | - Jasmit Shah
- Department of Paediatrics, Aga Khan University, Nairobi, Kenya
| | - Morris Ogero
- London School of Hygiene and Tropical Medicine, London, UK
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Miao Y, Zhou Y, Zhao S, Liu W, Wang A, Zhang Y, Li Y, Jiang H. Comparative efficacy and safety of caffeine citrate and aminophylline in treating apnea of prematurity: A systematic review and meta-analysis. PLoS One 2022; 17:e0274882. [PMID: 36121807 PMCID: PMC9484669 DOI: 10.1371/journal.pone.0274882] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Methylxanthine, including caffeine citrate and aminophylline, is the most common pharmacologic treatment for apnea of prematurity. However, due to the lack of high-quality evidence, there are no clear recommendations or guidelines on how to choose between caffeine and aminophylline.
Objective
This meta-analysis aimed to assess the comparative efficacy and safety of caffeine and aminophylline for apnea of prematurity, and provide reliable evidence for clinical medication in the treatment for apnea of prematurity.
Methods
PubMed, Scopus, Embase, EBSCO, Web of Science, and Cochrane databases were systematically searched from May 1975 to June 2022.
Results
Ten studies including a total of 923 preterm infants were evaluated. Our results showed that there was no significant difference in the effective rate of 1-3days between caffeine and aminophylline (OR 1.05, 95%CI: 0.40–2.74, P = 0.914). However, for side effects such as tachycardia (OR 0.22, 95%CI: 0.13–0.37, P<0.001) and feeding intolerance (OR 0.40, 95%CI: 0.23–0.70, P = 0.001), the incidence rate was lower in the caffeine group compared with the aminophylline group. No significant difference was found in hyperglycemia (OR 0.45, 95%CI: 0.19–1.05, P = 0.064).
Conclusion
This meta-analysis reveals that caffeine citrate and aminophylline have similar therapeutic effectiveness on respiratory function, but caffeine has fewer side effects and should be considered first for treatment.
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Affiliation(s)
- Yiqun Miao
- School of Nursing, Weifang Medical University, Weifang, Shandong Province, China
| | - Yun Zhou
- School of Nursing, Weifang Medical University, Weifang, Shandong Province, China
| | - Shuliang Zhao
- School of Nursing, Weifang Medical University, Weifang, Shandong Province, China
| | - Wenwen Liu
- School of Nursing, Weifang Medical University, Weifang, Shandong Province, China
| | - Aihua Wang
- School of Nursing, Weifang Medical University, Weifang, Shandong Province, China
- * E-mail:
| | - Yuanyuan Zhang
- School of Nursing, Weifang Medical University, Weifang, Shandong Province, China
| | - Yanan Li
- School of Nursing, Weifang Medical University, Weifang, Shandong Province, China
| | - Huimin Jiang
- School of Nursing, Weifang Medical University, Weifang, Shandong Province, China
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