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

Autor: Firman B; Newborn Services, Mater Mothers' Hospital, Brisbane, Queensland, Australia., Molnar A; Newborn Services, Mater Mothers' Hospital, Brisbane, Queensland, Australia., Gray PH; Newborn Services, Mater Mothers' Hospital, Brisbane, Queensland, Australia.; Mothers', Babies' and Women's Health Programme, Mater Research Institute, Brisbane, Queensland, Australia.
Jazyk: angličtina
Zdroj: Journal of paediatrics and child health [J Paediatr Child Health] 2019 Dec; Vol. 55 (12), pp. 1451-1457. Date of Electronic Publication: 2019 Mar 21.
DOI: 10.1111/jpc.14446
Abstrakt: 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.
(© 2019 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)
Databáze: MEDLINE
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