Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
J Pediatr. 2015 Jul;167(1):70-5. doi: 10.1016/j.jpeds.2015.04.040. Epub 2015 May 15.
To determine the effect of caffeine on diaphragmatic activity, tidal volume (Vt), and end-expiratory lung volume (EELV) in preterm infants.
Using transcutaneous electromyography of the diaphragm (dEMG), we measured diaphragmatic activity from 30 minutes before (baseline) to 3 hours after administration of an intravenous caffeine-base loading dose in 30 spontaneously breathing preterm infants (mean gestational age, 29.1 ± 1.3 weeks), most of whom were on noninvasive respiratory support. Diaphragmatic activity was expressed as the percentage change in dEMG amplitude, area under the curve, respiratory rate, and inspiratory and expiratory times. Using respiratory inductive plethysmography, we measured changes in Vt and EELV from baseline. These outcome variables were calculated at 8 fixed time points after caffeine administration (5, 15, 30, 60, 90, 120, 150, and 180 minutes) and compared with baseline.
Caffeine administration resulted in rapid (within 5 minutes) increases in dEMG amplitude (median, 43%; IQR, 24%-63%; P < .001) and area under the curve (median, 28%; IQR, 14%-48%; P < .001). Vt also increased by a median of 30% (IQR, 7%-48%), and this change was significantly correlated with the change in dEMG amplitude (r = 0.67; P < .001). These effects were relatively stable until 120 minutes after caffeine administration. Caffeine did not consistently impact EELV, respiratory rate, or inspiratory and expiratory times.
Caffeine treatment results in a rapid and sustained increase in diaphragmatic activity and Vt in preterm infants.
确定咖啡因对早产儿膈肌活动、潮气量（Vt）和呼气末肺容积（EELV）的影响。
使用经皮膈肌肌电图（dEMG），我们在 30 名接受静脉注射咖啡因负荷剂量的自主呼吸早产儿（平均胎龄 29.1±1.3 周）中，从给药前 30 分钟（基线）测量到给药后 3 小时，大多数早产儿接受无创呼吸支持。膈肌活动以 dEMG 幅度、曲线下面积、呼吸频率以及吸气和呼气时间的百分比变化表示。使用呼吸感应体积描记法，我们从基线测量 Vt 和 EELV 的变化。这些结局变量在咖啡因给药后 8 个固定时间点（5、15、30、60、90、120、150 和 180 分钟）进行计算，并与基线进行比较。
咖啡因给药后即刻（5 分钟内）增加 dEMG 幅度（中位数 43%，IQR 24%-63%；P<.001）和曲线下面积（中位数 28%，IQR 14%-48%；P<.001）。Vt 中位数增加 30%（IQR 7%-48%），且与 dEMG 幅度的变化显著相关（r=0.67；P<.001）。这些影响在咖啡因给药后 120 分钟内相对稳定。咖啡因对 EELV、呼吸频率或吸气和呼气时间没有一致的影响。
咖啡因治疗可使早产儿膈肌活动和 Vt 迅速而持续增加。
