High versus standard dose caffeine for apnoea: a systematic review
Vliegenthart R, Miedema M, Hutten GJ, van Kaam AH, Onland W
Archives of disease in childhood. Fetal and neonatal edition · 36 citations
Review labels
Neutral facts our review recorded about how this study was done. They describe method, never whether we like the result.
How it was studied
- Design
- Meta-analysis (indexed by PubMed)
- Studied in
- People
- Main outcome
- Clinical events such as disease or death
Who paid for it
- Funding
- Funding not disclosed
Publication
- Published
- 2018-02-07 · Arch Dis Child Fetal Neonatal Ed · vol. 103 · issue 6 · pp. F523–F529
- Publisher
- BMJ
- Cited
- 50 citations · more than 82% of similar papers · 1.6× the field average
- References
- 38 works
- Access
- Open access (repository copy) · OTHER-OA
- Research areas
- Neonatal Respiratory Health Research · Neuroscience of respiration and sleep · Infant Development and Preterm Care
- Keywords
- Caffeine, Medicine, Bronchopulmonary dysplasia, Placebo, Randomized controlled trial, Dose, Meta-analysis, Regimen, Pediatrics, Theophylline, Systematic review, Gestational age, MEDLINE, Internal medicine, Pregnancy
- MeSH
- humans, bronchopulmonary dysplasia, apnea, infant, premature, diseases, caffeine, central nervous system stimulants, treatment outcome, infant mortality, dose-response relationship, drug, infant, infant, newborn, infant, premature
5 authors
From NL
- Roos J. S. Vliegenthart · correspondingAmsterdam UMC Location University of Amsterdam; Emma Kinderziekenhuis
- Martijn MiedemaAmsterdam UMC Location University of Amsterdam; Emma Kinderziekenhuis
- Gerard J. HuttenAmsterdam UMC Location University of Amsterdam; Emma Kinderziekenhuis
- Anton H. van KaamAmsterdam UMC Location University of Amsterdam; Emma Kinderziekenhuis
- Wes OnlandAmsterdam UMC Location University of Amsterdam; Emma Kinderziekenhuis
Abstract
Background
Placebo-controlled trials have shown that caffeine is highly effective in treating apnoea of prematurity and reduces the risk of bronchopulmonary dysplasia (BPD) and neurodevelopmental impairment (NDI).
Objective
To identify, appraise and summarise studies investigating the modulating effect of different caffeine dosages.
Methods
A systematic review identified all randomised controlled trials (RCTs) comparing a high versus a standard caffeine treatment regimen in infants with a gestational age <32 weeks, by searching the main electronic databases and abstracts of the Pediatric Academic Societies. Studies comparing caffeine to placebo or theophylline only were excluded. Primary outcomes were BPD and mortality at 36 weeks postmenstrual age. Secondary key-outcome was neurodevelopmental outcome at 12 and 24 months corrected age. Meta-analysis was performed using RevMan 5.3.
Results
Six RCTs including 620 infants were identified. Meta-analysis showed a significant decrease in BPD, the combined outcome BPD or mortality, and failure to extubate in infants allocated to a higher caffeine dose. No differences were found in mortality alone and NDI. The quality of the outcome measures were deemed low to very low according to the Grading of Recommendations Assessment, Development and Evaluation guidelines.
Conclusions
Although this review suggests that administering a higher dose of caffeine might enhance its beneficial effect on death or BPD, firm recommendations on the optimal caffeine dose cannot be given due to the low level of evidence. A large RCT is urgently needed to confirm or refute these findings and determine the optimal dose of caffeine.
Abstract via Europe PMC. Copyright remains with the authors or publisher.
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