Review
Copyright ©The Author(s) 2015.
World J Clin Pediatr. Nov 8, 2015; 4(4): 81-93
Published online Nov 8, 2015. doi: 10.5409/wjcp.v4.i4.81
Table 2 Recommended caffeine doses
TrialDesignPopulationInterventionOutcomesMain results
Scanlon et al[48] United KingdomProspective, randomized, controlled trial44 preterm infants less than 31 wk gestationHigh (loading 25 mg/kg and maintenance 6 mg/kg per day) vs low (loading 12.5 mg/kg and maintenance 3 mg/kg per day) caffeine citrate given 24 h prior to extubationFrequency of apneaHigh dose caffeine significantly decreased the frequency of apnea
Steer et al[52] AustraliaProspective, randomized, blinded, controlled trial127 preterm infants less than 32 wk gestationThree dosing regimens of caffeine citrate (3, 15 and 30 mg/kg) for peri-extubation management of ventilated preterm infantsSuccessful extubation defined as staying off ventilation for 7 d post-extubationNo statistically significant difference in the incidence of successful extubation however, infants in the two higher dose groups had statistically significantly less documented apnea
Steer et al[53] AustraliaProspective, randomized, blinded, controlled trial234 preterm infants less than 30 wk gestation on mechanical ventilationHigh (loading 80 mg/kg and maintenance 20 mg/kg per day) vs low (loading 20 mg/kg and maintenance 5 mg/kg per day) caffeine citrate given 24 h prior to extubationPrimary: Successful extubation of mechanically ventilated infants Secondary: Frequency of apneaHigh dose caffeine significantly increased the chance for successful extubation, decreased the frequency of apnea and shortened the duration of respiratory support
Shah et al[54] SingaporeProspective, case control trialPreterm infants less than 34 wk gestationHigh (loading 20 mg/kg and maintenance 5 mg/kg per day) vs low (loading 10 mg/kg and maintenance 2.5 mg/kg per day) caffeine citratePrimary: Frequency of apnea, desaturation, and shallow breathing Secondary: Side effect of caffeine, BPD, and ROPHigh-dose caffeine significantly reduced episodes of apnea and shallow breathing without side effects
Gray et al[125] AustraliaProspective, randomized, blinded, controlled trial287 preterm infants less than 30 wk gestation exhibit AOP or require mechanical ventilationLoading dose of 40 mg/kg followed by two maintenance doses of either 20 or 5 mg/kg per dayPrimary: Cognitive development at 1 yr of age on the Griffiths Mental Development Scales Secondary: Neonatal morbidity, death and disability, temperament at 1 yr and behavior at 2 yr of ageHigh maintenance dose was associated with borderline benefit in cognitive outcome without increasing morbidity, temperament or behavior disorders
Mohammed et al[55] EgyptProspective, randomized, blinded, controlled trial120 preterm infants less than 32 wk gestation exhibit AOP or require mechanical ventilationHigh (loading 40 mg/kg and maintenance 20 mg/kg per day) vs low (loading 20 mg/kg and maintenance 10 mg/kg per day) caffeine citratePrimary: Successful extubation of mechanically ventilated infants Secondary: Frequency and documented days of apneaHigh dose caffeine significantly increased the chance for successful extubation, decreased frequency of apnea