1 Neonatal Services, Royal Women's Hospital, Melbourne, Australia.
2 Department of Obstetrics and Gynaecology and.
Am J Respir Crit Care Med. 2017 Nov 15;196(10):1318-1324. doi: 10.1164/rccm.201704-0767OC.
Caffeine in the newborn period shortens the duration of assisted ventilation and reduces the incidence of bronchopulmonary dysplasia, but its effects on respiratory function in later childhood are unknown.
To determine if children born with birth weight less than 1,251 g who were treated with neonatal caffeine had improved respiratory function at 11 years of age compared with children treated with placebo.
Children enrolled in the CAP (Caffeine for Apnea of Prematurity) randomized controlled trial and assessed at the Royal Women's Hospital in Melbourne at 11 years of age had expiratory flow rates measured according to the standards of the American Thoracic Society. Values were converted to z-scores predicted for age, height, ethnicity, and sex. Parents completed questionnaires related to their child's respiratory health.
A total of 142 children had expiratory flows measured. Expiratory flows were better in the caffeine group, by approximately 0.5 SD for most variables (e.g., FEV; mean z-score, -1.00 vs. -1.53; mean difference, 0.54; 95% confidence interval, 0.14-0.94; P = 0.008). Fewer children in the caffeine group had values for FVC below the fifth centile (11% vs. 28%; odds ratio, 0.31; 95% confidence interval, 0.12-0.77; P = 0.012). When adjusted for bronchopulmonary dysplasia, the difference in flow rates between groups diminished.
Caffeine treatment in the newborn period improves expiratory flow rates in midchildhood, which seems to be achieved by improving respiratory health in the newborn period. Follow-up lung function testing in adulthood is vital for these individuals. Future placebo-controlled randomized trials of neonatal caffeine are unlikely. Clinical trial registered with www.clinicaltrials.gov (NCT00182312).
新生儿期应用咖啡因可缩短辅助通气时间，降低支气管肺发育不良的发生率，但对儿童后期呼吸功能的影响尚不清楚。
确定胎龄小于 1251 克且接受新生咖啡因治疗的患儿与接受安慰剂治疗的患儿相比，11 岁时的呼吸功能是否得到改善。
在墨尔本皇家妇女医院入组 CAP（早产儿呼吸暂停咖啡因治疗）随机对照试验并在 11 岁时进行评估的患儿，根据美国胸科学会的标准测量呼气流量。根据年龄、身高、种族和性别，将数值转换为预测的 z 分数。父母完成与孩子呼吸健康相关的调查问卷。
共有 142 名患儿进行了呼气流量测量。咖啡因组的呼气流量更好，大多数变量的平均 z 分数高 0.5 个标准差（例如，FEV；平均 z 分数，-1.00 比-1.53；平均差值，0.54；95%置信区间，0.14-0.94；P = 0.008）。咖啡因组中 FVC 值低于第 5 百分位数的患儿较少（11%比 28%；比值比，0.31；95%置信区间，0.12-0.77；P = 0.012）。在校正支气管肺发育不良后，两组之间的流速差异减小。
新生儿期应用咖啡因治疗可改善儿童中期的呼气流量，这似乎是通过改善新生儿期的呼吸健康来实现的。这些个体在成年期进行后续的肺功能检查至关重要。不太可能进行新生儿咖啡因的安慰剂对照随机试验。临床试验在 www.clinicaltrials.gov 注册（NCT00182312）。
