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J Pediatr. 2014 May;164(5):992-998.e3. doi: 10.1016/j.jpeds.2013.12.025. Epub 2014 Jan 23.

Trends in caffeine use and association between clinical outcomes and timing of therapy in very low birth weight infants.

Author information

1
Department of Pediatrics, Uniformed Services University of Health Sciences, Bethesda, MD.
2
Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA.
3
Duke Clinical Research Institute, Duke University Medical Center, Durham, NC. Electronic address: brian.smith@duke.edu.
4
Department of Pediatrics, Womack Army Medical Center, Fort Bragg, NC.
5
Department of Biostatistics, University of North Carolina School of Public Health, Chapel Hill, NC.
6
Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC.

Erratum in

  • J Pediatr. 2014 May;164(5):1244.

Abstract

OBJECTIVE:

To examine the effect of early initiation of caffeine therapy on neonatal outcomes and characterize the use of caffeine therapy in very low birth weight (VLBW) infants.

STUDY DESIGN:

We analyzed a cohort of 62 056 VLBW infants discharged between 1997 and 2010 who received caffeine therapy. We compared outcomes in infants receiving early caffeine therapy (initial dose before 3 days of life) and those receiving late caffeine therapy (initial dose at or after 3 days of life) through propensity scoring using baseline and early clinical variables. The primary outcome was the association between the timing of caffeine initiation and the incidence of bronchopulmonary dysplasia (BPD) or death.

RESULTS:

We propensity score-matched 29 070 VLBW infants at a 1:1. Of infants receiving early caffeine therapy, 3681 (27.6%) died or developed BPD, compared with 4591 infants (34.0%) receiving late caffeine therapy (OR, 0.74; 99% CI, 0.69-0.80). Infants receiving early caffeine had a lower incidence of BPD (23.1% vs 30.7%; OR, 0.68; 95% CI, 0.63-0.73) and a higher incidence of death (4.5% vs 3.7%; OR, 1.23; 95% CI, 1.05-1.43). Infants receiving early caffeine therapy had less treatment of patent ductus arteriosus (OR, 0.60; 95% CI, 0.55-0.65) and a shorter duration of mechanical ventilation (mean difference, 6 days; P < .001).

CONCLUSION:

Early caffeine initiation is associated with a decreased incidence of BPD. Randomized trials are needed to determine the efficacy and safety of early caffeine prophylaxis in VLBW infants.

PMID:
24461786
PMCID:
PMC3992195
DOI:
10.1016/j.jpeds.2013.12.025
[Indexed for MEDLINE]
Free PMC Article

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