Advanced

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)
Please use this url to cite or link to this publication:
author
organization
publishing date
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 Publishing Ltd
external identifiers
  • scopus:85055884674
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
2019-07-16 04:00:39
@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 &gt;20 mg/kg and maintenance &gt;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},
  keyword      = {Cerebral palsy,Dose–response,Evidence-based medicine,Methylxanthine,Optimal information size},
  language     = {eng},
  number       = {3},
  pages        = {401--410},
  publisher    = {Wiley-Blackwell Publishing Ltd},
  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},
  volume       = {108},
  year         = {2019},
}