Caffeine is a risk factor for osteopenia of prematurity in preterm infants: a cohort study

Ebtihal Ali,Depeng Jiang,Cheryl Rockman-Greenberg,Michael Narvey,Martin Reed,Michael Moffatt

doi:10.1186/s12887-017-0978-6

Ebtihal Ali, Depeng Jiang + Show 4 more

Open Access

https://doi.org/10.1186/s12887-017-0978-6

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Abstract

BackgroundCaffeine, the most commonly used medication in Neonatal Intensive Care Units, has calciuric and osteoclastogenic effects.MethodsTo examine the association between the cumulative dose and duration of therapy of caffeine and osteopenia of prematurity, a retrospective cohort study was conducted including premature infants less than 31 weeks and birth weight less than 1500 g. Osteopenia of prematurity was evaluated using chest X-rays on a biweekly basis over 12 weeks of hospitalization.ResultsThe cohort included 109 infants. 51% had osteopenia of prematurity and 8% had spontaneous rib fractures. Using the generalized linear mixed model, caffeine dose and duration of caffeine therapy showed a strong association with osteopenia of prematurity. Steroids and vitamin D were also significantly correlated with osteopenia of prematurity while diuretic use did not show a statistically significant effect.ConclusionThe cumulative dose and duration of therapy of caffeine, as well as steroid are associated with osteopenia of prematurity in this cohort. Future studies are needed to confirm these findings and determine the lowest dose of caffeine needed to treat effectively apnea of prematurity.

Highlights

Caffeine, the most commonly used medication in Neonatal Intensive Care Units, has calciuric and osteoclastogenic effects
The initial cohort included 335 preterm infants, with gestational age (GA) of less than 31 weeks and birth weight less than 1500 g, who were admitted to the neonatal intensive care units (NICU) between July 2007 and July 2012
The results of GA, birth weight, sex, maternal parity and (TPN) duration are shown in Table 2 as mean ± 2SD, and average biweekly weight and vitamin D intake in Table 3 as mean ± 2SD

Summary

Introduction

The most commonly used medication in Neonatal Intensive Care Units, has calciuric and osteoclastogenic effects. Preterm infants whom deprived of that period, are born with less bone mineral content. Physiological adaptation of bone to extra-uterine life leads to an increase in bone resorption. This process occurs earlier in preterm than in term infants and can be accompanied by high risk of bone fragility and fractures [2]. The incidence and severity of osteopenia of prematurity increase as the birth weight (BW) and gestational age (GA) decrease [4]. Preterm infants are known to have a lower bone density (BMD) and bone mineral content (BMC) [2] at the corrected age of term, as well as a lower weight and Ponderal index [5]. Preterm infants have lower bone strength at the distal tibia and radius compared to age and sex-matched controls, when assessed with computerized tomography as young adults [6]

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