Francart Suzanne J, Allen Megan K, Stegall-Zanation Jennifer
Department of Pharmacy, The University of North Carolina Hospitals and Clinics, Chapel Hill, North Carolina.
J Pediatr Pharmacol Ther. 2013 Jan;18(1):45-52. doi: 10.5863/1551-6776-18.1.45.
The primary objective was to evaluate the correlation between maintenance dose and response rates in neonates less than 28 weeks gestational age. Secondary objectives included clinical indicators of response (number of weight adjustments, dose increases, and mini-loads) and tachycardia associated with caffeine therapy.
This study was a retrospective analysis of neonates admitted to the North Carolina Children's Hospital from August 2009 to August 2011. Patients included were less than 28 weeks postmenstrual age and were treated with caffeine for apnea of prematurity. Patients were excluded if they were older than 28 weeks postmenstrual age, receiving caffeine therapy for other indications, or experiencing apnea from other conditions, or if therapy was initiated more than 7 days after birth.
A total of 89 neonates with a mean birth weight of 0.844 kg (range: 0.391 to 1.306 kg) and median gestational age of 26 2/7 weeks (range: 23 to 27 6/7 weeks) were evaluated. The median initial maintenance dose of caffeine citrate was 7.9 mg/kg/day, and 94.1% of neonates receiving ≤7.9 mg/kg/day required a clinical intervention during therapy compared with 76.3% in those receiving >7.9 mg/kg/day. Absolute incidence of tachycardia was low, and caffeine levels collected ranged from 16.6 to 34.4 μg/mL.
In neonates less than 28 weeks gestational age, doses of caffeine citrate greater than 7.9 mg/kg/day are safe and are associated with a decreased need for clinical interventions.
主要目的是评估胎龄小于28周的新生儿维持剂量与反应率之间的相关性。次要目的包括反应的临床指标（体重调整次数、剂量增加次数和微量负荷量）以及与咖啡因治疗相关的心动过速。
本研究是对2009年8月至2011年8月入住北卡罗来纳州儿童医院的新生儿进行的回顾性分析。纳入的患者为孕龄小于28周且因早产呼吸暂停接受咖啡因治疗的新生儿。如果患者孕龄大于28周、因其他适应症接受咖啡因治疗、因其他情况出现呼吸暂停或出生后7天以上开始治疗，则将其排除。
共评估了89例新生儿，平均出生体重为0.844千克（范围：0.391至1.306千克），中位孕龄为26又2/7周（范围：23至27又6/7周）。枸橼酸咖啡因的中位初始维持剂量为7.9毫克/千克/天，接受≤7.9毫克/千克/天的新生儿中有94.1%在治疗期间需要临床干预，而接受>7.9毫克/千克/天的新生儿中这一比例为76.3%。心动过速的绝对发生率较低，采集的咖啡因水平范围为16.6至34.4微克/毫升。
在胎龄小于28周的新生儿中，枸橼酸咖啡因剂量大于7.9毫克/千克/天是安全的，且与临床干预需求的减少相关。
