Moschino Laura, Zivanovic Sanja, Hartley Caroline, Trevisanuto Daniele, Baraldi Eugenio, Roehr Charles Christoph
Dept of Women's and Children's Health, University of Padua, Padua, Italy.
Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
ERJ Open Res. 2020 Mar 2;6(1). doi: 10.1183/23120541.00330-2019. eCollection 2020 Jan.
The incidence of preterm birth is increasing, leading to a growing population with potential long-term pulmonary complications. Apnoea of prematurity (AOP) is one of the major challenges when treating preterm infants; it can lead to respiratory failure and the need for mechanical ventilation. Ventilating preterm infants can be associated with severe negative pulmonary and extrapulmonary outcomes, such as bronchopulmonary dysplasia (BPD), severe neurological impairment and death. Therefore, international guidelines favour non-invasive respiratory support. Strategies to improve the success rate of non-invasive ventilation in preterm infants include pharmacological treatment of AOP. Among the different pharmacological options, caffeine citrate is the current drug of choice. Caffeine is effective in reducing AOP and mechanical ventilation and enhances extubation success; it decreases the risk of BPD; and is associated with improved cognitive outcome at 2 years of age, and pulmonary function up to 11 years of age. The commonly prescribed dose (20 mg·kg loading dose, 5-10 mg·kg per day maintenance dose) is considered safe and effective. However, to date there is no commonly agreed standardised protocol on the optimal dosing and timing of caffeine therapy. Furthermore, despite the wide pharmacological safety profile of caffeine, the role of therapeutic drug monitoring in caffeine-treated preterm infants is still debated. This state-of-the-art review summarises the current knowledge of caff-eine therapy in preterm infants and highlights some of the unresolved questions of AOP. We speculate that with increased understanding of caffeine and its metabolism, a more refined respiratory management of preterm infants is feasible, leading to an overall improvement in patient outcome.
早产的发生率正在上升，导致可能出现长期肺部并发症的人群不断增加。早产儿呼吸暂停（AOP）是治疗早产儿时面临的主要挑战之一；它可导致呼吸衰竭并需要机械通气。对早产儿进行通气可能会带来严重的肺部和肺外不良后果，如支气管肺发育不良（BPD）、严重神经损伤和死亡。因此，国际指南倾向于采用无创呼吸支持。提高早产儿无创通气成功率的策略包括对AOP进行药物治疗。在不同的药物选择中，枸橼酸咖啡因是目前的首选药物。咖啡因在降低AOP和机械通气方面有效，并提高拔管成功率；它降低了BPD的风险；并且与2岁时认知结果改善以及11岁时肺功能改善相关。常用剂量（负荷剂量20mg·kg，每日维持剂量5 - 10mg·kg）被认为是安全有效的。然而，迄今为止，关于咖啡因治疗的最佳剂量和时机尚无普遍认可的标准化方案。此外，尽管咖啡因具有广泛的药物安全性，但治疗药物监测在接受咖啡因治疗的早产儿中的作用仍存在争议。这篇最新综述总结了目前关于早产儿咖啡因治疗的知识，并强调了一些关于AOP尚未解决的问题。我们推测，随着对咖啡因及其代谢的了解增加，对早产儿进行更精细的呼吸管理是可行的，从而全面改善患者结局。
