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Cited by 77Neonatal Respiratory Health ResearchNeuroscience of respiration and sleepInfant Development and Preterm Care

Periextubation caffeine in preterm neonates: a randomized dose response trial

Steer, PA, Flenady, VJ, Shearman, A, Lee, TC, Tudehope, DI, Charles, BG·2003·Journal of Paediatrics and Child Health
DOI 10.1046/j.1440-1754.2003.00207.x
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Abstract

OBJECTIVE: To compare the effectiveness of three dosing regimens of caffeine for preterm infants in the periextubation period. METHODS: A randomized double-blind clinical trial of three dosing regimens of caffeine citrate (3, 15 and 30 mg/kg) for periextubation management of ventilated preterm infants was undertaken. Infants born <32 weeks gestation who were ventilated for>48 h were eligible for the study. Caffeine citrate was given as a once daily dose for a period of 6 days commencing 24 h prior to a planned extubation, or within 6 h of an unplanned extubation. The primary outcome measure was extubation failure, defined as neonates who were unable to be extubated within 48 h of caffeine loading or who required reventilation or doxapram dose within 7 days of caffeine loading. Continuous recordings of oxygen saturation and heart rate were undertaken in a subgroup of enrolled infants. RESULTS: A total of 127 babies were enrolled into the study (42, 40, 45, in the 3, 15, and 30 mg/kg groups, respectively). No statistically significant difference was demonstrated in the incidence of extubation failure between dosing groups (19, 10, and 11 infants in the 3, 15, and 30 mg/kg groups, respectively), however, infants in the two higher dose groups had statistically significantly less documented apnoea than the lowest dose group. Of the 37 neonates with continuous pulse oximetry recordings, those on higher doses of caffeine recorded a statistically significantly higher mean heart rate, oxygen saturations and less time with oxygen saturations <85%. CONCLUSIONS: This trial indicated there were short-term benefits of decreased apnoea in the immediate periextubation period for ventilated infants born <32 weeks gestation receiving higher doses of caffeine. Further studies with larger numbers of infants assessing longer-term outcomes are necessary to determine the optimal dosing regimen of caffeine in preterm infants.

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  • For the 3 mg/kg bw dose, only 1 out of 42 pre-term infants showed tachycardia and jittering, and only tachycardia with no jittering was observed in 8 out of 45 infants at doses 100-fold higher (30 mg/kg bw).

    “For this dose, only 1 out of 42 pre-term infants showed tachycardia and jittering, and only tachycardia (with no jittering) was observed in 8 out of 45 infants at doses 100-fold higher (30 mg/kg bw).”

    From Scientific Opinion on the safety of caffeine (2015) · cites this paper as Steer et al., 2003

  • Daily caffeine intakes by the breastfed infant would not exceed 0.3 mg/kg bw, which is 10-fold below the lowest dose of 3 mg/kg bw tested in a dose finding study.

    “Daily caffeine intakes by the breastfed infant would not exceed 0.3 mg/kg bw (Hildebrandt and Gundert-Remy, 1983), which is 10-fold below the lowest dose of 3 mg/kg bw tested in a dose finding study (Steer et al., 2003).”

    From Scientific Opinion on the safety of caffeine (2015) · cites this paper as Steer et al., 2003

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Authors
Steer, P., Flenady, V., Shearman, A., Lee, T., Tudehope, D., & Charles, B.
Affiliations
The University of Queensland (AU)
Venue
Journal of Paediatrics and Child Health
Publisher
Wiley
Published
2003-09
Volume
39
Issue
7
Pages
511-515
ISSN
  • 1034-4810 (ISSN-L)
  • 1440-1754
DOI
10.1046/j.1440-1754.2003.00207.x
OpenAlex
W2093780574
Cited by
77
References
21
Citations by year
2026: 1 · 2025: 4 · 2024: 5 · 2023: 7 · 2022: 1 · 2021: 5 · 2020: 6 · 2019: 4 · 2018: 8 · 2017: 5 · 2016: 6 · 2015: 5 · 2014: 5 · 2013: 1 · 2012: 2
FWCI
0.81
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 15 d)
Locations
  • Journal of Paediatrics and Child Health (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Neonatal Respiratory Health Research
  • Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
Keywords
caffeine citrate, preterm infants, extubation failure, apnea, dose-response relationship, mechanical ventilation, neonatal respiratory support, oxygen saturation, heart rate
MeSH terms
Central Nervous System Stimulants, Apnea, Caffeine, Citrates, Dose-Response Relationship, Drug, Double-Blind Method, Doxapram, Drug Combinations, Female, Humans, Infant, Newborn, Infant, Premature, Intubation, Intratracheal, Male, Ventilator Weaning, Respiratory System Agents

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