Kaykı Gözdem, Çelik Hasan Tolga, Ayaz Ercan, Tandırcıoğlu Ümit Ayşe, Oğuz Berna, Yiğit Şule, Yurdakök Murat
Division of Neonatology, Department of Pediatrics, Hacettepe University, Ankara, Turkey.
Department of Radiology, Diyarbakır Children's Hospital, Diyarbakır, Turkey.
Turk Arch Pediatr. 2024 Apr 5;59(3):277-282. doi: 10.5152/TurkArchPediatr.2024.23290.
Caffeine is frequently used for the treatment of apnea in preterm babies. Its mechanism of action includes not only antagonism of adenosine receptors on central nervous system but also an increase in electrical activity of the diaphragm. Caffeine's direct effect on diaphragm was investigated via electromyography, but ultrasound has not been used to show visible changes in muscles after the treatment before. Therefore, we aimed to assess the effect of caffeine on diaphragmatic function through ultrasonographic examination. It was a prospective observational study. Fifty-six participants receiving nasal continuous positive airway pressure with less than or equal to 32 weeks' gestational age born were enrolled. Diaphragmatic thickness, amplitude of excursion, and velocity of movement were measured before and within 5 minutes after caffeine loading dose and compared to each other. The protocol was registered with ClinicalTrials.gov Identifier NCT04483492. Diaphragmatic thicknesses and diaphragmatic velocity of movement did not differ after the treatment. However, amplitude of excursion of the diaphragm was found significantly higher after caffeine loading dose (8.7 mm, 10mm, respectively, P < .05). Diaphragm excursion increased after caffeine treatment in preterm babies, and this finding was potentially supported the direct effect of the caffeine on diaphragm. Another important finding of this study is that it reinforces the utility of ultrasonography in assessing diaphragmatic function in preterm infants.
咖啡因常用于治疗早产儿呼吸暂停。其作用机制不仅包括拮抗中枢神经系统的腺苷受体，还包括增加膈肌的电活动。此前曾通过肌电图研究咖啡因对膈肌的直接作用，但尚未使用超声来显示治疗后肌肉的可见变化。因此，我们旨在通过超声检查评估咖啡因对膈肌功能的影响。这是一项前瞻性观察性研究。纳入了56名出生时胎龄小于或等于32周且接受鼻持续气道正压通气的参与者。在给予咖啡因负荷剂量前及给药后5分钟内测量膈肌厚度、移动幅度和移动速度，并进行相互比较。该方案已在ClinicalTrials.gov注册，标识符为NCT04483492。治疗后膈肌厚度和膈肌移动速度没有差异。然而，发现给予咖啡因负荷剂量后膈肌移动幅度明显更高（分别为8.7毫米、10毫米，P < 0.05）。咖啡因治疗后早产儿的膈肌移动增加，这一发现可能支持了咖啡因对膈肌的直接作用。本研究的另一个重要发现是，它强化了超声在评估早产儿膈肌功能方面的实用性。
