Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
Laboratory of Neonatal Disease, Institute of Pediatrics, Central South University, Changsha, Hunan, China.
Pediatr Pulmonol. 2020 Oct;55(10):2635-2640. doi: 10.1002/ppul.24948. Epub 2020 Jul 15.
Caffeine citrate is used to prevent apnea in premature infants and help in extubation of invasive ventilation, but the optimal dose remains undetermined.
Neonates born at less than 30 weeks gestation who had received invasive ventilation for at least 48 hours and a loading dose of 20 mg/kg caffeine citrate were randomly assigned into high (10 mg/kg daily) or low (5 mg/kg daily) maintenance dose groups. The drug was discontinued if no apnea occurred for 7 consecutive days.
A total of 111 infants were assigned into the high (54) or low (57) dose groups. Extubation failure (16.7% vs 36.8%), age of extubation (8.2 ± 2.1 vs 10.7 ± 2.3 day), duration of invasive ventilation (7.2 ± 2.1 vs 8.5 ± 2.4 day), duration of ventilation before extubation (8.0 ± 1.8 vs 10.1 ± 1.9 day), and number of days of apnea (1.8 ± 1.3 vs 3.2 ± 1.1 day) were significantly lower in the high dose group than the low dose group. Difference in time until failure (6.7 ± 1.7d vs 7.0 ± 1.9d) and duration of nasal continuous positive airway pressure(7.8 ± 1.8 vs 8.0 ± 2.2 day) were not significant. Furthermore, no significant differences in the incidence of tachycardia (9.3% vs 12.3%), abdominal distension (16.7% vs 12.3%), feeding intolerance (3.7% vs 5.3%), or irritability (7.4% vs 5.3%) were observed between groups.
A higher maintenance dose of caffeine citrate reduced the incidence of extubation failure and apnea of prematurity without increasing the occurrence of adverse reactions.
枸橼酸咖啡因被用于预防早产儿呼吸暂停和帮助有创通气撤机，但最佳剂量仍未确定。
胎龄小于 30 周、接受至少 48 小时有创通气且已给予负荷剂量 20mg/kg 枸橼酸咖啡因的新生儿，随机分为高（10mg/kg/d）或低（5mg/kg/d）维持剂量组。如果连续 7 天无呼吸暂停，则停止用药。
共有 111 名婴儿被分配到高（54 名）或低（57 名）剂量组。与低剂量组相比，高剂量组拔管失败率（16.7%比 36.8%）、拔管时龄（8.2±2.1 天比 10.7±2.3 天）、有创通气时间（7.2±2.1 天比 8.5±2.4 天）、拔管前通气时间（8.0±1.8 天比 10.1±1.9 天）和呼吸暂停天数（1.8±1.3 天比 3.2±1.1 天）显著降低。两组间到达失败的时间差异（6.7±1.7d 比 7.0±1.9d）和鼻塞持续气道正压通气时间（7.8±1.8 天比 8.0±2.2 天）无显著差异。此外，两组间心动过速（9.3%比 12.3%）、腹胀（16.7%比 12.3%）、喂养不耐受（3.7%比 5.3%）或烦躁（7.4%比 5.3%）的发生率也无显著差异。
枸橼酸咖啡因维持剂量较高可降低早产儿拔管失败和呼吸暂停的发生率，而不增加不良反应的发生。
