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J Pediatr. 2019 Aug;211:27-32.e1. doi: 10.1016/j.jpeds.2019.04.028. Epub 2019 May 14.

Dosing and Safety of Off-label Use of Caffeine Citrate in Premature Infants.

Author information

1
Department of Pediatrics, University of Washington, Seattle, WA; Department of Pediatrics, Duke University Medical Center, Durham, NC.
2
Department of Pediatrics, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC.
3
EMMES Corporation, Rockville, MD.
4
Duke Clinical Research Institute, Durham, NC.
5
Children's Hospitals and Clinics of Minnesota, Minneapolis, MN.
6
New Hanover Regional Medical Center, Coastal Carolina Neonatology, Wilmington, NC.
7
Hackensack University Medical Center, Hackensack, NJ.
8
Department of Pediatrics, Duke University Medical Center, Durham, NC.
9
Duke Clinical Research Institute, Durham, NC; Department of Pediatrics, University of North Carolina, Chapel Hill, NC.
10
Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA. Electronic address: Kelly.Wade@uphs.upenn.edu.

Abstract

OBJECTIVE:

To characterize the dosing and safety of off-label caffeine citrate in a contemporary cohort of extremely premature infants.

STUDY DESIGN:

We used electronic health records (2010-2013) from 4 neonatal intensive care units to identify infants of ≤28 weeks of gestational age exposed to caffeine citrate. Safety outcomes included death, bronchopulmonary dysplasia, necrotizing enterocolitis, spontaneous intestinal perforation, intraventricular hemorrhage, patent ductus arteriosus ligation, seizures, and arrhythmias. We used multivariable logistic regression to evaluate the association of caffeine citrate exposure with clinical events.

RESULTS:

Of 410 infants with a median (IQR) gestational age of 26 (24-27) weeks, 95% received caffeine citrate for >0 days. Infants received a median (IQR) daily dose of 8 (5-10) mg/kg/day. Incidences of clinical events on day of caffeine citrate exposure were death 2%, patent ductus arteriosus ligation 12%, and medical and surgical necrotizing enterocolitis 5% and 4%, respectively. Bronchopulmonary dysplasia occurred in 37% of infants and was not associated with caffeine dose. Increased caffeine citrate dose was associated with lower odds of patent ductus arteriosus ligation and necrotizing enterocolitis.

CONCLUSIONS:

Caffeine citrate was used in extremely premature infants at younger gestation, at higher doses, and for longer durations than recommended on the drug label. Increased caffeine citrate exposure, dose, or therapy duration was not associated with increased risk of necrotizing enterocolitis.

KEYWORDS:

apnea; bronchopulmonary dysplasia; necrotizing enterocolitis

PMID:
31101409
PMCID:
PMC6661003
[Available on 2020-08-01]
DOI:
10.1016/j.jpeds.2019.04.028

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