High-versus low-dose caffeine in preterm infants : a systematic review and meta-analysis
Brattström, Petter ; Russo, Chiara ; Ley, David LU and Bruschettini, Matteo LU
(2019)
In Acta Paediatrica, International Journal of Paediatrics
108(3).
p.401-410
- Abstract
Aim: Though caffeine is a consolidated treatment in preterm infants, the efficacy and safety of a higher dose have not been systematically appraised. Methods: A systematic review was conducted to compare high (loading dose >20 mg/kg and maintenance >10 mg/kg/day) versus low dose of caffeine. MEDLINE, EMBASE, Central and conference proceedings for randomised controlled trials (RCTs) and quasi-RCTs were searched. Two authors independently screened the records, extracted the data and assessed the risk of bias. Results: As only six RCTs enrolling a total of 816 preterm infants were included, the required information size was not reached. The loading and maintenance doses varied between 20 and 80 mg/kg/day and 3 and 20 mg/kg/day,... (More)
Aim: Though caffeine is a consolidated treatment in preterm infants, the efficacy and safety of a higher dose have not been systematically appraised. Methods: A systematic review was conducted to compare high (loading dose >20 mg/kg and maintenance >10 mg/kg/day) versus low dose of caffeine. MEDLINE, EMBASE, Central and conference proceedings for randomised controlled trials (RCTs) and quasi-RCTs were searched. Two authors independently screened the records, extracted the data and assessed the risk of bias. Results: As only six RCTs enrolling a total of 816 preterm infants were included, the required information size was not reached. The loading and maintenance doses varied between 20 and 80 mg/kg/day and 3 and 20 mg/kg/day, respectively. The use of high dose had no impact on mortality (RR: 0.85; 95% CI: 0.53–1.38; RCTs = 4) or bronchopulmonary dysplasia (RR: 0.93; 95% CI: 0.72–1.20; studies = 4); however, it resulted in fewer cases of extubation failure and apnoeas and shorter duration of mechanical ventilation. The quality of the evidence was low due to imprecision of the estimates. Conclusion: Due to imprecision, it is not possible to determine whether high-dose caffeine is more effective and safe than a low dose. High dose might improve short-term respiratory function without reducing bronchopulmonary dysplasia.
(Less)
- author
- Brattström, Petter
; Russo, Chiara
; Ley, David
LU
and Bruschettini, Matteo
LU
- organization
- publishing date
- 2019
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Cerebral palsy, Dose–response, Evidence-based medicine, Methylxanthine, Optimal information size
- in
- Acta Paediatrica, International Journal of Paediatrics
- volume
- 108
- issue
- 3
- pages
- 401 - 410
- publisher
- Wiley-Blackwell
- external identifiers
-
- scopus:85055884674
- pmid:30242903
- ISSN
- 0803-5253
- DOI
- 10.1111/apa.14586
- language
- English
- LU publication?
- yes
- id
- b0f98023-cc4e-4778-920f-97b8cf210dd1
- date added to LUP
- 2018-11-20 12:57:14
- date last changed
- 2024-06-10 22:20:29
@article{b0f98023-cc4e-4778-920f-97b8cf210dd1,
abstract = {{<p>Aim: Though caffeine is a consolidated treatment in preterm infants, the efficacy and safety of a higher dose have not been systematically appraised. Methods: A systematic review was conducted to compare high (loading dose >20 mg/kg and maintenance >10 mg/kg/day) versus low dose of caffeine. MEDLINE, EMBASE, Central and conference proceedings for randomised controlled trials (RCTs) and quasi-RCTs were searched. Two authors independently screened the records, extracted the data and assessed the risk of bias. Results: As only six RCTs enrolling a total of 816 preterm infants were included, the required information size was not reached. The loading and maintenance doses varied between 20 and 80 mg/kg/day and 3 and 20 mg/kg/day, respectively. The use of high dose had no impact on mortality (RR: 0.85; 95% CI: 0.53–1.38; RCTs = 4) or bronchopulmonary dysplasia (RR: 0.93; 95% CI: 0.72–1.20; studies = 4); however, it resulted in fewer cases of extubation failure and apnoeas and shorter duration of mechanical ventilation. The quality of the evidence was low due to imprecision of the estimates. Conclusion: Due to imprecision, it is not possible to determine whether high-dose caffeine is more effective and safe than a low dose. High dose might improve short-term respiratory function without reducing bronchopulmonary dysplasia.</p>}},
author = {{Brattström, Petter and Russo, Chiara and Ley, David and Bruschettini, Matteo}},
issn = {{0803-5253}},
keywords = {{Cerebral palsy; Dose–response; Evidence-based medicine; Methylxanthine; Optimal information size}},
language = {{eng}},
number = {{3}},
pages = {{401--410}},
publisher = {{Wiley-Blackwell}},
series = {{Acta Paediatrica, International Journal of Paediatrics}},
title = {{High-versus low-dose caffeine in preterm infants : a systematic review and meta-analysis}},
url = {{http://dx.doi.org/10.1111/apa.14586}},
doi = {{10.1111/apa.14586}},
volume = {{108}},
year = {{2019}},
}