Trends in Caffeine Use and Association between Clinical Outcomes and Timing of Therapy in Very-Low-Birth-Weight Infants
| Autor: | David P. Carlton, Ravi Mangal Patel, Carl E. Hunt, Nicole R. Dobson, Jennifer J.J. Clark, P. Brian Smith, Amy H. Herring, Devon Kuehn, Matthew M. Laughon, Shilpa Vyas-Read |
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| Jazyk: | angličtina |
| Rok vydání: | 2014 |
| Předmět: |
Male
Pediatrics medicine.medical_specialty Drug Administration Schedule Article law.invention Randomized controlled trial law Intensive care Caffeine Infant Mortality Medicine Humans Infant Very Low Birth Weight Practice Patterns Physicians' Propensity Score Ductus Arteriosus Patent Bronchopulmonary Dysplasia business.industry Incidence Incidence (epidemiology) Infant Newborn Gestational age Retinopathy of prematurity medicine.disease Respiration Artificial United States Low birth weight Treatment Outcome Bronchopulmonary dysplasia Pediatrics Perinatology and Child Health Necrotizing enterocolitis Intensive Care Neonatal Central Nervous System Stimulants Female medicine.symptom business Infant Premature |
| Popis: | Objective To examine the effect of early initiation of caffeine therapy on neonatal outcomes and characterize the use of caffeine therapy in very low birth weight (VLBW) infants. Study design We analyzed a cohort of 62056 VLBW infants discharged between 1997 and 2010 who received caffeinetherapy. Wecompared outcomes ininfantsreceiving earlycaffeine therapy (initial dosebefore 3days oflife) and those receiving late caffeine therapy (initial doseat orafter3 days oflife) throughpropensity scoring using baseline and early clinical variables. The primary outcome was the association between the timing of caffeine initiation and the incidence of bronchopulmonary dysplasia (BPD) or death. Results We propensity score–matched 29070 VLBW infants at a 1:1. Of infants receiving early caffeine therapy, 3681 (27.6%)diedordeveloped BPD,compared with4591infants(34.0%)receiving late caffeine therapy(OR, 0.74; 99% CI, 0.69-0.80). Infants receiving early caffeine had a lower incidence of BPD (23.1% vs 30.7%; OR, 0.68; 95% CI, 0.63-0.73) and a higher incidence of death (4.5% vs 3.7%; OR, 1.23; 95% CI, 1.05-1.43). Infants receiving early caffeine therapy had less treatment of patent ductus arteriosus (OR, 0.60; 95% CI, 0.55-0.65) and a shorter duration of mechanical ventilation (mean difference, 6 days; P < .001). Conclusion Early caffeine initiation is associated with a decreased incidence of BPD. Randomized trials are needed to determine the efficacy and safety of early caffeine prophylaxis in VLBW infants. (J Pediatr 2014;164:992-8). |
| Databáze: | OpenAIRE |
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