Medical University of Graz, Graz, Austria.
The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.
PLoS One. 2018 Jul 11;13(7):e0200572. doi: 10.1371/journal.pone.0200572. eCollection 2018.
Caffeine is routinely given to preterm infants hours after birth to treat apnea of prematurity. In view of it's success, earlier administration in the delivery room is being considered, but little is known about how caffeine may effect the cardiovascular changes during the fetal to neonatal transition. Our aim was to determine the effect of prenatal caffeine administration on haemodynamic parameters in ventilated preterm lambs immediately after birth.
Catheters (carotid artery and jugular vein) and ultrasonic flow probes (pulmonary artery and carotid artery) were implanted in preterm lambs (~126 ±2 days of gestation; term is 147 days), immediately before delivery by caesarean section. Before the cord was clamped, lambs were intubated and a caffeine (10mg/kg caffeine-base; n = 9) or saline (n = 5) infusion was given intravenously to the ewe and lamb over a 15-minute period. Two minutes after clamping the cord, ventilation commenced with a sustained inflation (35 cm H2O for 30 seconds) followed by ventilation for 30 minutes (target tidal volume of 6-8ml/kg).
Blood gas parameters and rectal body temperature were not different between the two groups. Changes in pulmonary blood flow (PBF) and carotid blood flow (CBF) did not differ significantly between groups. PBF increased significantly after ventilation onset in both groups (caffeine p = 0.022, saline p <0.001) and remained elevated thereafter. CBF did not increase but decreased after SI in the caffeine group. Blood pressure, heart rate, and peripheral oxygen saturation did not differ between groups at any stage of the study.
Prenatal caffeine infusion had no significant effect on acute haemodynamic parameters in ventilated preterm lambs during the cardiorespiratory transition.
咖啡因通常在早产儿出生数小时后用于治疗早产儿呼吸暂停。鉴于其成功，人们正在考虑更早地在产房内给药，但对于咖啡因如何影响胎儿到新生儿过渡期间的心血管变化知之甚少。我们的目的是确定产前给予咖啡因对出生后立即接受通气的早产儿羊血流动力学参数的影响。
在通过剖宫产分娩前，将导管（颈动脉和颈静脉）和超声流量探头（肺动脉和颈动脉）植入早产羊（~126±2 天妊娠；足月为 147 天）中。在脐带夹闭之前，羊被插管，咖啡因（10mg/kg 咖啡因碱；n=9）或生理盐水（n=5）静脉输注到母羊和羔羊中，持续 15 分钟。脐带夹闭后 2 分钟，用持续膨胀（35cmH2O 持续 30 秒）开始通气，随后通气 30 分钟（目标潮气量为 6-8ml/kg）。
两组血气参数和直肠体温无差异。两组间肺血流量（PBF）和颈血流量（CBF）的变化无显著差异。通气开始后，两组的 PBF 均显著增加（咖啡因组 p=0.022，生理盐水组 p<0.001），此后持续升高。在咖啡因组中，SI 后 CBF 没有增加反而减少。在研究的任何阶段，两组的血压、心率和外周血氧饱和度均无差异。
产前咖啡因输注对通气早产儿在心肺过渡期间的急性血液动力学参数没有显著影响。
