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Pediatrics. 2019 Jan;143(1). pii: e20181348. doi: 10.1542/peds.2018-1348. Epub 2018 Dec 5.

Early Caffeine Administration and Neurodevelopmental Outcomes in Preterm Infants.

Author information

1
Departments of Pediatrics and aklodha@ucalgary.ca.
2
Community Health Sciences and.
3
Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.
4
University of Alberta, Edmonton, Alberta, Canada.
5
Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
6
Departments of Pediatrics and.
7
Sainte Justine University Health Center, University of Montreal, Montreal, Quebec, Canada.
8
Maternal-Infant Care Research Center, Mount Sinai Hospital, Toronto, Ontario, Canada.
9
Department of Pediatrics, Sinai Health System, Toronto, Ontario, Canada; and.
10
Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.

Abstract

BACKGROUND:

Although caffeine use for apnea of prematurity is well studied, the long-term safety and benefit of routine early caffeine administration has not been explored. Our objective was to determine the association between early (within 2 days of birth) versus late caffeine exposure and neurodevelopmental outcomes in preterm infants.

METHODS:

Infants of <29 weeks' gestation born between April 2009 and September 2011 and admitted to Canadian Neonatal Network units and then assessed at Canadian Neonatal Follow-up Network centers were studied. Neonates who received caffeine were divided into early- (received within 2 days of birth) and late-caffeine (received after 2 days of birth) groups. The primary outcome was significant neurodevelopmental impairment, defined as cerebral palsy, or a Bayley Scales of Infant and Toddler Development, Third Edition composite score of <70 on any component, hearing aid or cochlear implant, or bilateral visual impairment at 18 to 24 months' corrected age.

RESULTS:

Of 2108 neonates who were eligible, 1545 were in the early-caffeine group and 563 were in the late-caffeine group. Rates of bronchopulmonary dysplasia, patent ductus arteriosus, and severe neurologic injury were lower in the early-caffeine group than in the late-caffeine group. Significant neurodevelopmental impairment (adjusted odds ratio 0.68 [95% confidence interval 0.50-0.94]) and odds of Bayley Scales of Infant and Toddler Development, Third Edition cognitive scores of <85 (adjusted odds ratio 0.67 [95% confidence interval 0.47-0.95]) were lower in the early-caffeine group than in the late-caffeine group. Propensity score-based matched-pair analyses revealed lower odds of cerebral palsy and hearing impairment only.

CONCLUSIONS:

Early caffeine therapy is associated with better neurodevelopmental outcomes compared with late caffeine therapy in preterm infants born at <29 weeks' gestation.

PMID:
30518670
DOI:
10.1542/peds.2018-1348

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

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