Sandra Nylander Vujovic1, Chiara Nava2, Minna Johansson3, Matteo Bruschettini4,5. 1. Skane University Hospital, Lund, Sweden. 2. University of Milano-Bicocca, Monza, Italy. 3. Cochrane Sweden, Skane University Hospital, Lund, Sweden. 4. Cochrane Sweden, Skane University Hospital, Lund, Sweden. matteo.bruschettini@med.lu.se. 5. Department of Clinical Sciences Lund, Paediatrics, Lund University, Skane University Hospital, Lund, Sweden. matteo.bruschettini@med.lu.se.
Abstract
BACKGROUND: Caffeine is indicated for the management of apnoea of prematurity and extubation in preterm infants. Early initiation of caffeine administration has increased in the past decades with the purpose of reducing respiratory morbidity. However, there might be harms associated with this approach. This systematic review aims to assess whether early administration of caffeine reduces morbidity and mortality in preterm infants. METHODS: The methods were published in a preregistered protocol. The literature search was performed in February 2019 with no restrictions for language or publication date. Randomised controlled trials (RCTs) and cohort studies comparing early versus late caffeine administration to infants born before week 34 were included. RESULTS: Two RCTs and 14 cohort studies were included. All studies but one had a serious/critical overall risk of bias. Few studies reported on long-term or patient-relevant outcomes. No meta-analysis could be performed. CONCLUSION: Based on the available evidence, no conclusions about the optimal timing of caffeine administration can be drawn. There are inherent methodological problems in the cohort studies. RCTs are needed to answer the question of optimal timing for caffeine administration in neonatal care. Future trials should focus on outcomes relevant to patients and their families and include long-term outcomes.
BACKGROUND:Caffeine is indicated for the management of apnoea of prematurity and extubation in preterm infants. Early initiation of caffeine administration has increased in the past decades with the purpose of reducing respiratory morbidity. However, there might be harms associated with this approach. This systematic review aims to assess whether early administration of caffeine reduces morbidity and mortality in preterm infants. METHODS: The methods were published in a preregistered protocol. The literature search was performed in February 2019 with no restrictions for language or publication date. Randomised controlled trials (RCTs) and cohort studies comparing early versus late caffeine administration to infants born before week 34 were included. RESULTS: Two RCTs and 14 cohort studies were included. All studies but one had a serious/critical overall risk of bias. Few studies reported on long-term or patient-relevant outcomes. No meta-analysis could be performed. CONCLUSION: Based on the available evidence, no conclusions about the optimal timing of caffeine administration can be drawn. There are inherent methodological problems in the cohort studies. RCTs are needed to answer the question of optimal timing for caffeine administration in neonatal care. Future trials should focus on outcomes relevant to patients and their families and include long-term outcomes.
Authors: Abhay Lodha; Mary Seshia; Douglas D McMillan; Keith Barrington; Junmin Yang; Shoo K Lee; Prakesh S Shah Journal: JAMA Pediatr Date: 2015-01 Impact factor: 16.193
Authors: Barbara Schmidt; Robin S Roberts; Peter Davis; Lex W Doyle; Keith J Barrington; Arne Ohlsson; Alfonso Solimano; Win Tin Journal: N Engl J Med Date: 2006-05-18 Impact factor: 91.245
Authors: Barbara Schmidt; Robin S Roberts; Peter Davis; Lex W Doyle; Keith J Barrington; Arne Ohlsson; Alfonso Solimano; Win Tin Journal: N Engl J Med Date: 2007-11-08 Impact factor: 91.245