Early high‐dose caffeine citrate for extremely preterm infants: Neonatal and neurodevelopmental outcomes

• Published in: Journal of paediatrics and child health Vol. 55; no. 12; pp. 1451 - 1457
• Main Authors: Firman, Brooke, Molnar, Attila, Gray, Peter H
• Format: Journal Article
• Language: English
• Published: Australia John Wiley & Sons Australia, Ltd 01.12.2019; Blackwell Publishing Ltd
• Subjects: Adult; Caffeine; Caffeine - administration & dosage; Caffeine - adverse effects; cerebellar haemorrhage; Cerebral Hemorrhage - chemically induced; Child development; Citrates - administration & dosage; Citrates - adverse effects; cranial ultrasound; Databases, Factual; Dose-Response Relationship, Drug; Gestational Age; Humans; Infant, Extremely Premature; Morbidity; neurodevelopment; Neurology; Newborn babies; Outcome Assessment, Health Care; Premature babies; Premature birth; preterm infants; Retrospective Studies; Risk Assessment; caffeine; neurodevelopment; cranial ultrasound; preterm infants; cerebellar haemorrhage
• ISSN: 1034-4810; 1440-1754
• DOI: 10.1111/jpc.14446

Aim To examine neonatal morbidities, including the incidence of cerebellar haemorrhage (CBH), and neurodevelopmental outcomes following the administration of high loading dose caffeine citrate compared to standard loading dose caffeine citrate. Methods This was a retrospective study of 218 preterm infants <28 weeks’ gestation who received a loading dose of caffeine citrate within the first 36 h of life at the Mater Mothers' Hospital over a 3‐year period (2011–2013). Two groups were compared, with 158 neonates in the high‐dose cohort receiving a median dose of caffeine citrate of 80 mg/kg and 60 neonates in the standard dose cohort receiving a median dose of 20 mg/kg. Routine cranial ultrasound, including mastoid views, was performed during the neonatal period. At 2 years of age, infants presented for follow‐up and were assessed with the Neurosensory Motor Developmental Assessment (NSMDA) and the Bayley Scales of Infant and Toddler Development‐III (Bayley‐III). Results There was no difference in the incidence of neonatal morbidities, including CBH, between the two groups. The incidence of CBH in the high‐dose group was 2.5% compared to 1.7% in the standard‐dose group. There was no difference in the neurodevelopmental follow‐up scores as evaluated with the NSMDA and the Bayley‐III. Conclusions The use of early high loading dose caffeine citrate in extremely preterm infants was not shown to be associated with CBH or abnormal long‐term neurodevelopmental outcomes. The overall incidence of CBH, however, was much lower than in studies using magnetic resonance imaging techniques. It is suggested that a large randomised clinical trial is needed to determine the optimal dose of caffeine citrate when given early to very preterm infants.