Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Curr Opin Pediatr. 2018 Apr;30(2):177-181. doi: 10.1097/MOP.0000000000000588.
Caffeine use in preterm infants has endured several paradigms: from standard of care to possible neurotoxin to one of the few medications for which there is evidence of bronchopulmonary dysplasia (BPD) risk reduction. The purpose of the review is to analyze this dynamic trajectory and discuss controversies that still remain after decades of caffeine use.
Following concerns for caffeine safety in preterm infants, a large randomized controlled trial demonstrated a reduction in BPD and treatment for patent ductus arteriosus. The lower rate of death or neurodevelopmental impairment noted at 18-21 months was not statistically different at later timepoints; however, infants in the caffeine group had lower rates of motor impairment at 11-year follow-up. The time of caffeine therapy initiation is now substantially earlier, and doses used are sometimes higher that previously used, but there are limited data to support these practices.
Caffeine therapy for apnea of prematurity (AOP) remains one of the pillars of neonatal care, although more evidence to support dosing and timing of initiation and discontinuation are needed.
早产儿中咖啡因的使用经历了几个阶段：从常规治疗到可能的神经毒素，再到为数不多的有证据表明能降低支气管肺发育不良（BPD）风险的药物之一。综述的目的是分析这一动态轨迹，并讨论在使用咖啡因几十年后仍然存在的争议。
在对早产儿咖啡因安全性的担忧之后，一项大型随机对照试验表明，BPD 和动脉导管未闭（PDA）的治疗减少。在 18-21 个月时，死亡或神经发育障碍的发生率较低，但在以后的时间点没有统计学差异；然而，在 11 年的随访中，咖啡因组的婴儿运动障碍发生率较低。咖啡因治疗的开始时间现在大大提前，使用的剂量有时比以前更高，但支持这些做法的数据有限。
咖啡因治疗早产儿呼吸暂停（AOP）仍然是新生儿护理的基石之一，尽管需要更多的证据来支持剂量和开始及停止的时间。
