The Influence of Dosage and Timing of Caffeine Administration on Neurodevelopmental Outcome of Very Preterm Infants

Abstract

Objective: To analyze starting time (early versus late) and duration of caffeine treatment and its possible influence on neurodevelopmental (ND) outcome in very preterm infants. Hypothesis: Early initiation of caffeine treatment with longer duration of treatment may significantly improve ND outcome in very preterm infants. Design: Retrospective cohort study. Setting: Level III Neonatal Intensive care Unit (NICU) and out-patient NICU follow-up clinic of an academic medical center in New York City. Participants: A total of 146 inborn infants with gestational ages (GA) of 23-32 weeks who received caffeine treatment were included in this study with the following exclusion criteria: incomplete clinical data, insufficient ND follow-up and transfer of infants to other facilities. Interventions: Information on the administration of Caffeine Citrate injection USP and Caffeine Citrate oral solution (20 mg/ml equivalent to 10 mg caffeine base) including duration of treatment were obtained from individual chart reviews. Primary outcome measure: Normal and adverse (mild/moderate, severe) ND outcome. Results: Duration and starting point (early versus late) of caffeine treatment were not associated with ND outcome; adjusted for GA, head ultrasound (HUS) results and gender. The only significant predictor of ND outcome was GA. Conclusion: Gestational age (GA) seems to have more of an influence on ND outcome than caffeine citrate treatment regardless of duration (i.e., dose) and onset (early versus late) of such treatment.