Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.
School of Pharmacy, University of Auckland, Auckland, New Zealand.
J Perinatol. 2024 Jun;44(6):785-801. doi: 10.1038/s41372-024-01939-x. Epub 2024 Mar 29.
This systematic review and meta-analysis evaluated the evidence for dose and effectiveness of caffeine in preterm infants. MEDLINE, EMBASE, CINHAL Plus, CENTRAL, and trial databases were searched to July 2022 for trials randomizing preterm infants to caffeine vs. placebo/no treatment, or low (≤10 mg·kg) vs. high dose (>10 mg·kg caffeine citrate equivalent). Two researchers extracted data and assessed risk of bias using RoB; GRADE evaluation was completed by all authors. Meta-analysis of 15 studies (3530 infants) was performed in REVMAN across four epochs: neonatal/infant (birth-1 year), early childhood (1-5 years), middle childhood (6-11 years) and adolescence (12-19 years). Caffeine reduced apnea (RR 0.59; 95%CI 0.46,0.75; very low certainty) and bronchopulmonary dysplasia (0.77; 0.69,0.86; moderate certainty), with higher doses more effective. Caffeine had no effect on neurocognitive impairment in early childhood but possible benefit on motor function in middle childhood (0.72; 0.57,0.91; moderate certainty). The optimal dose remains unknown; further long-term studies, are needed.
这篇系统评价和荟萃分析评估了咖啡因在早产儿中的剂量和疗效的证据。检索了 MEDLINE、EMBASE、CINHAL Plus、CENTRAL 和试验数据库，以获取 2022 年 7 月之前将早产儿随机分配到咖啡因与安慰剂/无治疗或低（≤10mg·kg）与高剂量（>10mg·kg 枸橼酸咖啡因等效物）的试验。两位研究人员使用 RoB 提取数据并评估偏倚风险；所有作者均完成 GRADE 评估。在 REVMAN 中对 15 项研究（3530 名婴儿）进行了荟萃分析，分为四个时期：新生儿/婴儿期（出生至 1 岁）、幼儿期（1-5 岁）、儿童中期（6-11 岁）和青春期（12-19 岁）。咖啡因可减少呼吸暂停（RR 0.59；95%CI 0.46,0.75；极低确定性）和支气管肺发育不良（0.77；0.69,0.86；中等确定性），高剂量更有效。咖啡因对幼儿期的神经认知障碍没有影响，但对儿童中期的运动功能可能有益（0.72；0.57,0.91；中等确定性）。最佳剂量仍不清楚；需要进一步的长期研究。
