Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
The Ritchie Center, MIMR-PHI Institute of Medical Research, Melbourne, Victoria, Australia.
Pediatr Res. 2017 Aug;82(2):290-296. doi: 10.1038/pr.2017.45. Epub 2017 May 17.
BackgroundCaffeine promotes spontaneous breathing by antagonizing adenosine. We assessed the direct effect of caffeine on respiratory effort in preterm infants at birth.MethodsThirty infants of 24-30 weeks of gestation were randomized for receiving caffeine directly after birth in the delivery room (caffeine DR group) or later in the neonatal intensive care unit (control group). Primary outcome was respiratory effort, expressed as minute volume, tidal volumes, respiratory rate, rate of rise to maximum tidal volume, and recruitment breaths at 7-9 min after birth.ResultsAfter correction for gestational age, minute volumes ((mean±SD; 189±74 vs. 162±70 ml/kg/min; P<0.05) and tidal volumes ((median (interquartile range (IQR)) 5.2 (3.9-6.4) vs. 4.4 (3.0-5.6) ml/kg) were significantly greater in the caffeine DR group. Although respiratory rates were similar ((mean±SD) 35±10 vs. 33±10), RoR increased significantly ((median (IQR) 14.3 (11.2-19.8) vs. 11.2 (7.9-15.2) ml/kg/s), and more recruitment breaths were observed (13 vs. 9%).ConclusionCaffeine increases respiratory effort in preterm infants at birth, but the effect on clinical outcomes needs further investigation.
背景
咖啡因通过拮抗腺苷促进自主呼吸。我们评估了咖啡因对出生时早产儿呼吸努力的直接影响。
方法
30 名 24-30 周龄的婴儿随机分为出生后在产房（咖啡因 DR 组）或新生儿重症监护病房（对照组）接受咖啡因治疗。主要结局是出生后 7-9 分钟时的呼吸努力，用分钟通气量、潮气量、呼吸频率、最大潮气量上升率和募集呼吸表示。
结果
校正胎龄后，分钟通气量（（均值±标准差；189±74 比 162±70 ml/kg/min；P<0.05）和潮气量（中位数（四分位间距（IQR））5.2（3.9-6.4）比 4.4（3.0-5.6）ml/kg）在咖啡因 DR 组显著更大。虽然呼吸频率相似（（均值±标准差）35±10 比 33±10），但 RoR 显著增加（中位数（IQR）14.3（11.2-19.8）比 11.2（7.9-15.2）ml/kg/s），并且观察到更多的募集呼吸（13 比 9%）。
结论
咖啡因增加出生时早产儿的呼吸努力，但对临床结局的影响需要进一步研究。
