早期咖啡因给药对初始接受有创机械通气的极早产儿呼吸结局的影响。
Impact of early caffeine administration on respiratory outcomes in very preterm infants initially receiving invasive mechanical ventilation.
机构信息
Party Committee Office, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong, China.
出版信息
BMJ Open Respir Res. 2024 Aug 28;11(1):e002285. doi: 10.1136/bmjresp-2023-002285.
OBJECTIVE
The guidelines recommend early caffeine administration for preterm infants requiring non-invasive mechanical ventilation since earlier treatment is associated with better outcomes. The objective was to evaluate the impact of early caffeine therapy (within 24 hours after birth) on respiratory outcomes in very preterm infants who were initially receiving invasive mechanical ventilation.
METHODS
This was an observation cohort study from 1 January 2018 to 31 December 2022 based on a database that was prospectively collected and maintained. Infants who initially received invasive mechanical ventilation were divided into two groups based on the timing of caffeine initiation: within the first 24 hours after birth (early) and within 48 hours of birth or later (late). Generalised linear mixed models with a random effect model for the centre were used to assess the impact of different caffeine initiation times on neonatal outcomes.
RESULTS
Among the cohort of 9880 infants born at <32 weeks gestation, 2381 were eligible for this study (early initiation: 1758 (73.8%) and late initiation: 623 (26.2%)). For infants born at more than 28 weeks of gestation, the adjusted generalised linear mixed model showed that the duration of invasive mechanical ventilation was 1.34 (95% CI -2.40 to -0.27) days shorter and the incidence of moderate-to-severe bronchopulmonary dysplasia (BPD) was lower (adjusted OR 0.63; 95% CI 0.41 to 0.96) in the early caffeine group compared with the late caffeine group.
CONCLUSION
In very preterm infants who initially receive invasive mechanical ventilation, early administration of caffeine within 24 hours after birth can shorten the duration of invasive mechanical ventilation, reduce the incidence of moderate-to-severe BPD and improve respiratory outcomes. The very early initiation of caffeine treatment does not appear to be associated with any adverse outcomes.
TRIAL REGISTRATION NUMBER
ChiCTR1900025234.
目的
指南建议对需要接受无创机械通气的早产儿尽早给予咖啡因治疗，因为早期治疗与更好的结局相关。本研究旨在评估在最初接受有创机械通气的极早产儿中，早期（出生后 24 小时内）给予咖啡因治疗对呼吸结局的影响。
方法
这是一项基于前瞻性收集和维护的数据库的 2018 年 1 月 1 日至 2022 年 12 月 31 日的观察性队列研究。根据咖啡因起始时间，将最初接受有创机械通气的婴儿分为两组：出生后 24 小时内（早期）和出生后 48 小时或之后（晚期）。采用具有中心随机效应模型的广义线性混合模型来评估不同咖啡因起始时间对新生儿结局的影响。
结果
在<32 周胎龄出生的 9880 名婴儿中，有 2381 名符合本研究条件（早期起始：1758 名[73.8%]；晚期起始：623 名[26.2%]）。对于胎龄大于 28 周的婴儿，调整后的广义线性混合模型显示，有创机械通气的持续时间缩短了 1.34 天（95%CI-2.40 至-0.27），中重度支气管肺发育不良（BPD）的发生率降低（调整后的 OR 0.63；95%CI 0.41 至 0.96）。
结论
在最初接受有创机械通气的极早产儿中，出生后 24 小时内早期给予咖啡因可缩短有创机械通气的持续时间，降低中重度 BPD 的发生率，并改善呼吸结局。早期开始给予咖啡因治疗似乎不会导致任何不良结局。
试验注册号
ChiCTR1900025234。
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