Caffeine for preterm infants: Fixed standard dose, adjustments for age or high dose?

Abstract

Caffeine is an effective treatment for apnea of prematurity and has several important benefits, including decreasing respiratory morbidity and motor impairment. In this article, we focus on the dose of caffeine. We review the evidence regarding the efficacy and safety of standard caffeine dosing and alternative dosing approaches, including the use of high dose caffeine and routine dose adjustments for age. Current evidence suggests high dose caffeine may provide additional benefit in reducing the risk of bronchopulmonary dysplasia and extubation failure, but may also increase the risk of cerebellar hemorrhage and seizures. Increasing the standard caffeine citrate dose every 1-2 weeks to a goal dose of 8 mg per kilogram every 24 h may help maintain therapeutic effect. We conclude by highlighting the need for additional trials before high dose caffeine is routinely used.

• Authors: Vivek Saroha, Ravi Mangal Patel
• Journal: Seminars in fetal & neonatal medicine (Semin Fetal Neonatal Med) Vol. 25 Issue 6 Pg. 101178 (12 2020) ISSN: 1878-0946 [Electronic] Netherlands
• PMID: 33168464 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Review)
• Copyright: © 2020 Published by Elsevier Ltd.

Chemical References

• Citrates
• Caffeine
• caffeine citrate

Topics

• Apnea (drug therapy)
• Bronchopulmonary Dysplasia (drug therapy)
• Caffeine (administration & dosage)
• Cerebral Hemorrhage (prevention & control)
• Citrates (administration & dosage)
• Dose-Response Relationship, Drug
• Humans
• Infant
• Infant, Newborn
• Infant, Newborn, Diseases (drug therapy)
• Infant, Premature
• Infant, Premature, Diseases (drug therapy)