Acute hemodynamic effects of caffeine administration in premature infants.

OBJECTIVE: Administration of caffeine citrate (caffeine) has been a central component of the treatment of apnea of prematurity. However, given its multiple pharmacologic effects, caffeine might be expected to produce hemodynamic changes in heart rate, stroke volume, cardiac output and vascular resistance. STUDY
DESIGN: In this prospective observational study, we report the hemodynamic effects of intravenous caffeine administration in a population of premature infants who received caffeine to correct or prevent apnea of prematurity.
METHODS: Hemodynamic effects of caffeine were determined in 31 infants. Stroke volume was measured via echocardiogram, using velocity time integral at the aortic root diameter. Statistically univariate analyses were performed parametrically using paired t-test and nonparametrically (sign test). Multivariate linear regression models were used to identify subgroup covariate effects.
RESULTS: After intravenous caffeine, cardiac index increased in 31 of 31 trials, by an average of 14.6+/-16.3% (s.d.); stroke volume increased in 24 of 31 trials, by 7.8+/-12.2%; heart rate increased in 28 of 31 trials by 7.7+/-7.2 beats per min; and blood pressure increased in 25 of 31 trials, by 4.1+/-5.8 mm Hg (all P<0.001). Multivariate linear regression revealed no significant effect of dose, birth weight, gestational age or postnatal age.
CONCLUSIONS: Intravenous caffeine consistently increases cardiac output and blood pressure in relatively stable premature infants, when given to treat or prevent apnea of prematurity. We speculate that there may be a role for caffeine in the hemodynamic treatment of hypotensive/hypoperfused infants.