Effect of Very Early Use of Caffeine Citrate in Preterm Neonates Needing Respiratory Support

Abstract

Caffeine citrate is one of the most widely used medication in the neonatal intensive care units. It is a respiratory stimulant which has well-established therapeutic effects in apnoea and extubation. Over the past four decades, caffeine has been used for the treatment of apneoa of prematurity and facilitate weaning from mechanical ventilation. Recent studies have indicated that early initiation of caffeine therapy is associated with improved neonatal outcomes. Respiratory distress syndrome occurs with highest frequency in preterm neonates <1000gm and lowest frequency in preterm neonates 1500-2000gm. Respiratory distress syndrome (RDS) is a breathing disorder that affects newborns. RDS rarely occurs in full-term infants and more common in preterm neonates. The disorder is more common in premature infants due to deficient surfactant. The onset of symptoms is always within hours after birth and in severe cases may occur with the first few breaths after delivery Neonates with respiratory distress syndrome should be treated with warming, good hydration, effecient nutrition, antibiotics, supplemental oxygen according to need and exogenous surfactant may be needed. Our study was carried out in Ain Shams University hospitals in the period between January 2018 and December 2018 on 54 preterem neonates less than 34 weeks who require respiratory support and were given caffeine citrate in two different timings. First group was given caffeine citrate once started respiratory support while the second group was given caffeine citrate before weaning of oxygen within six hours. The results showed that early caffeine admnistration lead to shorter duration of mechanical ventillation, oxygen therapy and NICU stay. There was no association between caffeine citrate and complications which means that the early use of caffeine citrate does not add to the morbidity which may be caused by the drug itself.