咖啡因与氨茶碱治疗早产儿呼吸暂停的长期神经发育结局

Long-term neurodevelopment outcome of caffeine versus aminophylline therapy for apnea of prematurity.

作者信息

Khurana S, Shivakumar M, Sujith Kumar Reddy G V, Jayashree P, Ramesh Bhat Y, Lewis L E S

机构信息

Department of Physiotherapy, School of Allied Health Sciences, Madhav Nagar, Manipal University, Manipal, Karnataka, India.

Department of Pediatrics, Neonatology Unit, Kasturba Medical College, Madhav Nagar, Manipal University, Manipal, Karnataka, India.

出版信息

J Neonatal Perinatal Med. 2017;10(4):355-362. doi: 10.3233/NPM-16147.

DOI:10.3233/NPM-16147

PMID:29286928

Abstract

OBJECTIVE

Methylxanthines are the most commonly prescribed drug in neonatal setups. However, Clinicians show indecision in choosing the right agent for Apnea of Prematurity in most of the developing countries. Present study aimed to compare rate of mortality and survival with normal neurodevelopment outcome at 18 to 24 months of corrected age, between Caffeine- and Aminophylline-treated infants for apnea of prematurity.

METHODS

240 infants were randomly allocated to caffeine and aminophylline for apnea of prematurity during February 2012 to January 2015. Long-term neurodevelopmental assessment was done only from children who had attained corrected age of 18 to 24 months during April 2014 to February 2016. Cognitive, language and motor deficits were assessed by Bayley Scale of infant and toddler development (BSID - III). Postnatal characteristics such as hearing and visual impairments during NICU stay were noted and same were followed up.

RESULTS

Infants allocated to caffeine group showed 83% less risk of getting cognitive impairment (RR 0.16; CI 95% range 0.02 to 1.36), 50% less risk of developing motor deficits (RR 0.50; CI 95% range 0.12 to 1.95) and 24% less risk of developing language problems (RR 0.76; CI 95% range 0.36 to 1.58). However in all the neurodevelopment domains the difference between groups was not statistically significant. Risk of mortality in caffeine group was 9% less over aminophylline group which was statistically non-significant (RR - 0.92; CI 95% range - 0.45 to 1.84; p = 0.81). Physical growth parameters were found to be similar in both the groups. Risk of developing visual abnormality and hearing impairments was also statistically non-significant between the groups.

CONCLUSION

Caffeine and aminophylline showed similar effects in reducing the rate of mortality and improving the survival without neurodevelopment delays; though the clinical significance of caffeine over aminophylline cannot be undermined.

摘要

目的

甲基黄嘌呤是新生儿治疗中最常用的药物。然而，在大多数发展中国家，临床医生在为早产儿呼吸暂停选择合适药物时犹豫不决。本研究旨在比较咖啡因和氨茶碱治疗早产儿呼吸暂停后，在矫正年龄18至24个月时的死亡率以及存活且神经发育正常的情况。

方法

2012年2月至2015年1月期间，将240名早产儿随机分配至咖啡因组和氨茶碱组进行呼吸暂停治疗。仅对2014年4月至2016年2月期间矫正年龄达到18至24个月的儿童进行长期神经发育评估。通过贝利婴幼儿发展量表（BSID - III）评估认知、语言和运动缺陷。记录新生儿重症监护病房（NICU）住院期间的听力和视力损害等出生后特征，并进行随访。

结果

分配至咖啡因组的婴儿出现认知障碍的风险降低83%（相对危险度RR 0.16；95%置信区间CI范围0.02至1.36），出现运动缺陷的风险降低50%（RR 0.50；CI 95%范围0.12至1.95），出现语言问题的风险降低24%（RR 0.76；CI 95%范围0.36至1.58）。然而，在所有神经发育领域，两组之间的差异无统计学意义。咖啡因组的死亡率比氨茶碱组低9%，但差异无统计学意义（RR - 0.92；CI 95%范围 - 0.45至1.84；p = 0.81）。发现两组的身体生长参数相似。两组之间出现视觉异常和听力损害的风险在统计学上也无显著差异。