Caffeine to Improve Breathing Effort of Preterm Infants at Birth: a Randomized Controlled Trial

Overview

Journal Pediatr Res

Specialties Biology
Pediatrics

Date 2017 Mar 14

PMID 28288150

Citations 38

Authors

Janneke Dekker

Stuart B Hooper

Jeroen J van Vonderen

Ruben S G M Witlox

Enrico Lopriore

Arjan B Te Pas

Affiliations

Soon will be listed here.

Abstract

BackgroundCaffeine promotes spontaneous breathing by antagonizing adenosine. We assessed the direct effect of caffeine on respiratory effort in preterm infants at birth.MethodsThirty infants of 24-30 weeks of gestation were randomized for receiving caffeine directly after birth in the delivery room (caffeine DR group) or later in the neonatal intensive care unit (control group). Primary outcome was respiratory effort, expressed as minute volume, tidal volumes, respiratory rate, rate of rise to maximum tidal volume, and recruitment breaths at 7-9 min after birth.ResultsAfter correction for gestational age, minute volumes ((mean±SD; 189±74 vs. 162±70 ml/kg/min; P<0.05) and tidal volumes ((median (interquartile range (IQR)) 5.2 (3.9-6.4) vs. 4.4 (3.0-5.6) ml/kg) were significantly greater in the caffeine DR group. Although respiratory rates were similar ((mean±SD) 35±10 vs. 33±10), RoR increased significantly ((median (IQR) 14.3 (11.2-19.8) vs. 11.2 (7.9-15.2) ml/kg/s), and more recruitment breaths were observed (13 vs. 9%).ConclusionCaffeine increases respiratory effort in preterm infants at birth, but the effect on clinical outcomes needs further investigation.

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References

Schilleman K, van der Pot C, Hooper S, Lopriore E, Walther F, Te Pas A . Evaluating manual inflations and breathing during mask ventilation in preterm infants at birth. J Pediatr. 2012; 162(3):457-63. DOI: 10.1016/j.jpeds.2012.09.036. View

Harding R, Bocking A, Sigger J . Influence of upper respiratory tract on liquid flow to and from fetal lungs. J Appl Physiol (1985). 1986; 61(1):68-74. DOI: 10.1152/jappl.1986.61.1.68. View

Siew M, Wallace M, Kitchen M, Lewis R, Fouras A, Te Pas A . Inspiration regulates the rate and temporal pattern of lung liquid clearance and lung aeration at birth. J Appl Physiol (1985). 2009; 106(6):1888-95. DOI: 10.1152/japplphysiol.91526.2008. View

van Vonderen J, Hooper S, Hummler H, Lopriore E, Te Pas A . Effects of a sustained inflation in preterm infants at birth. J Pediatr. 2014; 165(5):903-8.e1. DOI: 10.1016/j.jpeds.2014.06.007. View

Te Pas A, Wong C, Kamlin C, Dawson J, Morley C, Davis P . Breathing patterns in preterm and term infants immediately after birth. Pediatr Res. 2009; 65(3):352-6. DOI: 10.1203/PDR.0b013e318193f117. View

Kooi E, van der Laan M, Verhagen E, van Braeckel K, Bos A . Volume expansion does not alter cerebral tissue oxygen extraction in preterm infants with clinical signs of poor perfusion. Neonatology. 2013; 103(4):308-14. DOI: 10.1159/000346383. View

Darnall R, Bruce R . Effects of adenosine and xanthine derivatives on breathing during acute hypoxia in the anesthetized newborn piglet. Pediatr Pulmonol. 1987; 3(2):110-6. DOI: 10.1002/ppul.1950030213. View

Comer A, Perry C, Figgitt D . Caffeine citrate: a review of its use in apnoea of prematurity. Paediatr Drugs. 2001; 3(1):61-79. DOI: 10.2165/00128072-200103010-00005. View

Aranda J, Gorman W, Bergsteinsson H, Gunn T . Efficacy of caffeine in treatment of apnea in the low-birth-weight infant. J Pediatr. 1977; 90(3):467-72. DOI: 10.1016/s0022-3476(77)80718-x. View

10.

Finer N, Carlo W, Walsh M, Rich W, Gantz M, Laptook A . Early CPAP versus surfactant in extremely preterm infants. N Engl J Med. 2010; 362(21):1970-9. PMC: 3071534. DOI: 10.1056/NEJMoa0911783. View

11.

Irestedt L, Dahlin I, Hertzberg T, Sollevi A, Lagercrantz H . Adenosine concentration in umbilical cord blood of newborn infants after vaginal delivery and cesarean section. Pediatr Res. 1989; 26(2):106-8. DOI: 10.1203/00006450-198908000-00007. View

12.

Wall S, Lee A, Niermeyer S, English M, Keenan W, Carlo W . Neonatal resuscitation in low-resource settings: what, who, and how to overcome challenges to scale up?. Int J Gynaecol Obstet. 2009; 107 Suppl 1:S47-62, S63-4. PMC: 2875104. DOI: 10.1016/j.ijgo.2009.07.013. View

13.

ODonnell C, Kamlin C, Davis P, Morley C . Crying and breathing by extremely preterm infants immediately after birth. J Pediatr. 2010; 156(5):846-7. DOI: 10.1016/j.jpeds.2010.01.007. View

14.

Dobson N, Patel R, Smith P, Kuehn D, Clark J, Vyas-Read S . Trends in caffeine use and association between clinical outcomes and timing of therapy in very low birth weight infants. J Pediatr. 2014; 164(5):992-998.e3. PMC: 3992195. DOI: 10.1016/j.jpeds.2013.12.025. View

15.

Kraaijenga J, Hutten G, de Jongh F, van Kaam A . The Effect of Caffeine on Diaphragmatic Activity and Tidal Volume in Preterm Infants. J Pediatr. 2015; 167(1):70-5. DOI: 10.1016/j.jpeds.2015.04.040. View

16.

Schmidt B, Roberts R, Davis P, Doyle L, Barrington K, Ohlsson A . Caffeine therapy for apnea of prematurity. N Engl J Med. 2006; 354(20):2112-21. DOI: 10.1056/NEJMoa054065. View

17.

Lodha A, Seshia M, McMillan D, Barrington K, Yang J, Lee S . Association of early caffeine administration and neonatal outcomes in very preterm neonates. JAMA Pediatr. 2014; 169(1):33-8. DOI: 10.1001/jamapediatrics.2014.2223. View

18.

Trevisanuto D, Satariano I, Doglioni N, Criscoli G, Cavallin F, Gizzi C . Changes over time in delivery room management of extremely low birth weight infants in Italy. Resuscitation. 2014; 85(8):1072-6. DOI: 10.1016/j.resuscitation.2014.04.024. View

19.

Katheria A, Sauberan J, Akotia D, Rich W, Durham J, Finer N . A Pilot Randomized Controlled Trial of Early versus Routine Caffeine in Extremely Premature Infants. Am J Perinatol. 2015; 32(9):879-86. DOI: 10.1055/s-0034-1543981. View

20.

Lee A, Cousens S, Wall S, Niermeyer S, Darmstadt G, Carlo W . Neonatal resuscitation and immediate newborn assessment and stimulation for the prevention of neonatal deaths: a systematic review, meta-analysis and Delphi estimation of mortality effect. BMC Public Health. 2011; 11 Suppl 3:S12. PMC: 3231885. DOI: 10.1186/1471-2458-11-S3-S12. View