High versus Low Dose Caffeine as Respiratory Stimulant in Preterm Infants

Abstract

Background: Caffeine is one of the widely used medications in the neonatal care units. Its use for treatment of apnea of prematurity (AOP) is well established over the past few years, yet the optimal loading and maintenance dose of caffeine in preterm infants is not well-studied. Objective: The aim of this study is to determine if the use of caffeine in doses higher than the currently standard dose can decrease the frequency of apnea in preterm infants without causing significant side effects. Subjects and Methods: This is a randomized, observational clinical trial that was conducted at the Neonatal Intensive Care Unit (NICU), Ain Shams University hospitals over a period of 1 year from October 2018 to October 2019. The study was done on a total of 80 preterm infants with gestational age between 28 and 34 weeks. The infants were divided randomly into 2 equal groups each contain 40 infants. Infants in Group (A) received low-dose regimen caffeine citrate loading dose of 20 mg/kg/day (equivalent to 10 mg/kg/day of caffeine base) and maintenance dose of 10 mg/kg/day (equivalent to 5 mg/kg/day of caffeine base). While infants in Group (B) received high-dose regimen caffeine citrate loading dose of 40 mg/kg/day (equivalent to 20 mg /kg/day of caffeine base) and maintenance dose of 20 mg/kg/day (equivalent to 10 mg /kg/day of caffeine base). Physical examination, vital data monitoring, and anthropometric measures were all followed up during the study time. Success of treatment is considered when there is no apnea during the first week of treatment, and failure is considered if apnea still present within the first week of treatment. Results: The results of our study show that there is statistically significant higher success rate among cases treated with high dose caffeine than low dose caffeine. 11 cases treated with low dose caffeine (27.5%) had apnea versus 4 cases among cases treated with high dose caffeine (10%). Conclusion: The use of higher, than current standard, dose of caffeine in preterm infants may decrease the frequency of Attacks of Apnea of Prematurity without significant side effects.