Abstract
The incidence of preterm birth is increasing, leading to a growing population with potential long-term pulmonary complications. Apnoea of prematurity (AOP) is one of the major challenges when treating preterm infants; it can lead to respiratory failure and the need for mechanical ventilation. Ventilating preterm infants can be associated with severe negative pulmonary and extrapulmonary outcomes, such as bronchopulmonary dysplasia (BPD), severe neurological impairment and death. Therefore, international guidelines favour non-invasive respiratory support. Strategies to improve the success rate of non-invasive ventilation in preterm infants include pharmacological treatment of AOP. Among the different pharmacological options, caffeine citrate is the current drug of choice. Caffeine is effective in reducing AOP and mechanical ventilation and enhances extubation success; it decreases the risk of BPD; and is associated with improved cognitive outcome at 2 years of age, and pulmonary function up to 11 years of age. The commonly prescribed dose (20 mg·kg−1 loading dose, 5–10 mg·kg−1 per day maintenance dose) is considered safe and effective. However, to date there is no commonly agreed standardised protocol on the optimal dosing and timing of caffeine therapy. Furthermore, despite the wide pharmacological safety profile of caffeine, the role of therapeutic drug monitoring in caffeine-treated preterm infants is still debated. This state-of-the-art review summarises the current knowledge of caffeine therapy in preterm infants and highlights some of the unresolved questions of AOP. We speculate that with increased understanding of caffeine and its metabolism, a more refined respiratory management of preterm infants is feasible, leading to an overall improvement in patient outcome.
Abstract
Caffeine is the current drug of choice to prevent and treat apnoea of prematurity. There is no agreed protocol on the optimal timing and dosage of caffeine therapy for preterm babies. Data on caffeine metabolism may optimise individualised therapy. http://bit.ly/2LMuJPY
Footnotes
Support statement: The authors gratefully acknowledge that L. Moschino is the recipient of the European Respiratory Society Short-term Research Fellowship 2017, and C. Hartley received grants from The Wellcome Trust and the Royal Society during the writing of the manuscript.
Conflict of interest: L. Moschino reports an ERS Short-Term Research Fellowship 2017 during the writing of this article.
Conflict of interest: S. Zivanovic has nothing to disclose.
Conflict of interest: C. Hartley reports grants from The Wellcome Trust and the Royal Society during the writing of this article.
Conflict of interest: D. Trevisanuto has nothing to disclose.
Conflict of interest: E. Baraldi has nothing to disclose.
Conflict of interest: C.C. Roehr reports that donations for processing laboratory samples were received from Chiesi Pharmaceuticals (Parma, Italy) for conducting an investigator-initiated study on caffeine metabolism in newborn infants. None of the content of this review relates to the company, their donation or the product they distribute. The company has not been involved in the writing of the review.
- Received November 28, 2019.
- Accepted December 4, 2019.
- Copyright ©ERS 2020
This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.