不同维持剂量枸橼酸咖啡因治疗需要辅助通气的早产儿的临床效果：一项多中心初步研究。
Clinical effect of different maintenance doses of caffeine citrate in the treatment of preterm infants requiring assisted ventilation: a pilot multicenter study.
机构信息
Department of Neonatology, Children's Hospital of Nanjing Medical University, Nanjing 210000, China).
出版信息
Zhongguo Dang Dai Er Ke Za Zhi. 2022 Mar 15;24(3):240-248. doi: 10.7499/j.issn.1008-8830.2109144.
OBJECTIVES
To explore the optimal maintenance dose of caffeine citrate for preterm infants requiring assisted ventilation and caffeine citrate treatment.
METHODS
A retrospective analysis was performed on the medical data of 566 preterm infants (gestational age ≤34 weeks) who were treated and required assisted ventilation and caffeine citrate treatment in the neonatal intensive care unit of 30 tertiary hospitals in Jiangsu Province of China between January 1 and December 31, 2019. The 405 preterm infants receiving high-dose (10 mg/kg per day) caffeine citrate after a loading dose of 20 mg/kg within 24 hours after birth were enrolled as the high-dose group. The 161 preterm infants receiving low-dose (5 mg/kg per day) caffeine citrate were enrolled as the low-dose group.
RESULTS
Compared with the low-dose group, the high-dose group had significant reductions in the need for high-concentration oxygen during assisted ventilation (=0.044), the duration of oxygen inhalation after weaning from noninvasive ventilation (<0.01), total oxygen inhalation time during hospitalization (<0.01), the proportion of preterm infants requiring noninvasive ventilation again (<0.01), the rate of use of pulmonary surfactant and budesonide (<0.05), and the incidence rates of apnea and bronchopulmonary dysplasia (<0.01), but the high-dose group had a significantly increased incidence rate of feeding intolerance (=0.032). There were no significant differences between the two groups in the body weight change, the incidence rates of retinopathy of prematurity, intraventricular hemorrhage or necrotizing enterocolitis, the mortality rate, and the duration of caffeine use (>0.05).
CONCLUSIONS
This pilot multicenter study shows that the high maintenance dose (10 mg/kg per day) is generally beneficial to preterm infants in China and does not increase the incidence rate of common adverse reactions. For the risk of feeding intolerance, further research is needed to eliminate the interference of confounding factors as far as possible.
目的
探索需要辅助通气和咖啡因枸橼酸盐治疗的早产儿的枸橼酸咖啡因最佳维持剂量。
方法
对 2019 年 1 月 1 日至 12 月 31 日期间中国江苏省 30 家三级医院新生儿重症监护病房（NICU）接受治疗并需要辅助通气和咖啡因枸橼酸盐治疗的 566 例（胎龄≤34 周）早产儿的医疗数据进行回顾性分析。对出生后 24 小时内给予负荷剂量 20mg/kg 后接受高剂量（10mg/kg/天）咖啡因枸橼酸盐的 405 例早产儿进行了研究，将其纳入高剂量组。对接受低剂量（5mg/kg/天）咖啡因枸橼酸盐的 161 例早产儿进行了研究，将其纳入低剂量组。
结果
与低剂量组相比，高剂量组在辅助通气时需要高浓度氧气的比例（=0.044）、经无创通气脱机后吸氧时间（<0.01）、住院期间总吸氧时间（<0.01）、再次需要无创通气的早产儿比例（<0.01）、肺表面活性物质和布地奈德的使用率（<0.05）和呼吸暂停和支气管肺发育不良的发生率（<0.01）均显著降低，但高剂量组的喂养不耐受发生率（=0.032）显著增加。两组间体重变化、早产儿视网膜病变、脑室出血或坏死性小肠结肠炎的发生率、死亡率和咖啡因使用时间的差异均无统计学意义（>0.05）。
结论
本项多中心初步研究表明，在中国，高维持剂量（10mg/kg/天）通常对早产儿有益，且不会增加常见不良反应的发生率。对于喂养不耐受的风险，需要进一步研究以尽可能消除混杂因素的干扰。
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