Subscribe to RSS
DOI: 10.1055/s-0041-1727157
Effects of Different Onset Times of Early Caffeine Treatment on Mesenteric Tissue Oxygenation and Necrotizing Enterocolitis: A Prospective, Randomized Study
Abstract
Objective Caffeine treatment is routinely used in premature infants to prevent development of apnea and bronchopulmonary dysplasia. Although a limited number of studies have reported that early caffeine treatment may cause development of necrotizing enterocolitis (NEC) by reducing mesenteric blood flow, this issue is still under discussion. The aim of this study is to investigate the possible effect of different onset times of early caffeine treatment on mesenteric tissue oxygen saturation and NEC development in premature infants.
Study Design A total of 87 preterm infants with ≤1,250-g birth weight (BW) was included in this prospective study. The cases were randomized as group 1 (first 24 hours) and group 2 (72nd hour) caffeine treatment groups and monitored by near-infrared spectroscopy (NIRS) for 72 hours from the time of admission until cerebral, renal, and mesenteric tissue oxygen saturations (rSO2) were recorded. The cases were followed-up to the 40th week in terms of NEC and other neonatal morbidities.
Results A total of 87 infants were included in the study, including 45 in group 1 and 42 in group 2. The groups were similar in terms of demographic characteristics. The incidence of NEC in group 1 (20%) was higher in comparison to group 2 (9%). The mesenteric rSO2 values in the first 72 hours of group 1 were lower than those of group 2. Low gestational week, BW, and late onset of enteral feeding were found to be other significant risk factors for NEC.
Conclusion In this study, mesenteric tissue oxygenation was lower, and NEC was higher in group 1. Mesenteric rSO2 measurements may be useful in predicting the development of NEC in patients receiving early caffeine therapy.
Key Points
-
Onset time of early caffeine treatment may effect on mesenteric tissue oxygen saturation.
-
Caffeine treatment that onset in the first 24 hours may be associated with NEC development.
-
Mesenteric rSO2 measurements may be useful in patients receiving early caffeine therapy.
Publication History
Received: 20 October 2020
Accepted: 18 February 2021
Article published online:
20 April 2021
© 2021. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Schmidt B, Roberts RS, Davis P. et al; Caffeine for Apnea of Prematurity Trial Group. Caffeine therapy for apnea of prematurity. N Engl J Med 2006; 354 (20) 2112-2121
- 2 Dobson NR, Patel RM, Smith PB. et al. Trends in caffeine use and association between clinical outcomes and timing of therapy in very low birth weight infants. J Pediatr 2014; 164 (05) 992-998.e3
- 3 Taha D, Kirkby S, Nawab U. et al. Early caffeine therapy for prevention of bronchopulmonary dysplasia in preterm infants. J Matern Fetal Neonatal Med 2014; 27 (16) 1698-1702
- 4 Lodha A, Seshia M, McMillan DD. et al; Canadian Neonatal Network. Association of early caffeine administration and neonatal outcomes in very preterm neonates. JAMA Pediatr 2015; 169 (01) 33-38
- 5 Neu J, Walker WA. Necrotizing enterocolitis. N Engl J Med 2011; 364 (03) 255-264
- 6 Noerr B. Current controversies in the understanding of necrotizing enterocolitis. Part 1. Adv Neonatal Care 2003; 3 (03) 107-120
- 7 Food and Drug Administration. New drug application: CAFCIT (NDA). 020793 . Accessed March 8, 2021 at: https://www.accessdata.fda.gov/drugsatfda_docs/nda/99/020793_000_CafcitTOC.cfm
- 8 Abdel Wahed MA, Issa HM, Khafagy SM, Abdel Raouf SM. Effect of caffeine on superior mesenteric artery blood flow velocities in preterm neonates. J Matern Fetal Neonatal Med 2019; 32 (03) 357-361
- 9 Eichenwald EC. Committee on Fetus and Newborn, American Academy of Pediatrics. Apnea of prematurity. Pediatrics 2016; 137 (01) 1-7
- 10 Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am 1986; 33 (01) 179-201
- 11 Walti H, Couchard M, Relier JP. Neonatal diagnosis of respiratory distress syndrome. Eur Respir J Suppl 1989; 3: 22s-26s
- 12 Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92 (04) 529-534
- 13 International Committee for the Classification of Retinopathy of Prematurity. The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol 2005; 123 (07) 991-999
- 14 Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163 (07) 1723-1729
- 15 Lampkin SJ, Turner AM, Lakshminrusimha S. et al. Association between caffeine citrate exposure and necrotizing enterocolitis in preterm infants. Am J Health Syst Pharm 2013; 70 (07) 603-608
- 16 Park HW, Lim G, Chung S-H, Chung S, Kim KS, Kim S-N. Early caffeine use in very low birth weight infants and neonatal outcomes: a systematic review and meta-analysis. J Korean Med Sci 2015; 30 (12) 1828-1835
- 17 Cox C, Hashem NG, Tebbs J, Bookstaver PB, Iskersky V. Evaluation of caffeine and the development of necrotizing enterocolitis. J Neonatal Perinatal Med 2015; 8 (04) 339-347
- 18 Amaro CM, Bello JA, Jain D. et al. Early caffeine and weaning from mechanical ventilation in preterm infants: a randomized, placebo-controlled trial. J Pediatr 2018; 196: 52-57
- 19 Abdel-Hady H, Nasef N, Shabaan AE, Nour I. Caffeine therapy in preterm infants. World J Clin Pediatr 2015; 4 (04) 81-93