Comparison of the Effectiveness of Maintenance Doses of Caffeine Citrate on Tracheal Tube Removal and Apnea After it in Premature Infants Hospitalized in the Neonatal Intensive Care Unit: A Randomized Clinical Trial

IF 1 Q4 PHARMACOLOGY & PHARMACY
Elahe Raeisi Estabragh, Bahareh Bahman Bijari, Zahra Jamali, Fatemeh Sabzevari, Mahdie Eslamian, Marjan Nikvarz, Mohammad Amin Raeisi Estabragh, Zahra Daee
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Abstract

Background: Respiratory distress ranks among the leading causes of mortality and morbidity in premature infants, with intubation and mechanical ventilation being prominent aggressive treatments. Caffeine citrate, a widely used methylxanthine, treats apnea of prematurity in such infants. However, the efficacy of high caffeine doses remains contentious. Objectives: This study aimed to evaluate the effectiveness and side effects of maintenance doses of caffeine citrate in facilitating tracheal tube removal and reducing subsequent apnea episodes in premature infants in neonatal intensive care units. Methods: Conducted as a randomized clinical trial at Afzalipur Hospital in Kerman, Iran, in 2023, this study involved eighty neonates with gestational ages under 35 weeks. They were divided into two groups: One received an initial caffeine citrate dose of 20 mg/kg followed by a maintenance dose of 5 mg/kg per day until the infant exhibited no apnea for at least 7 days post-extubation, while the other group received a maintenance dose of 10 mg/kg. Variables such as gestational age, sex, weight, and Apgar scores at one and five minutes post-birth were analyzed. The study assessed the effectiveness of caffeine citrate doses in terms of tracheal tube removal and reduction in apnea incidents, with secondary outcomes including patent ductus arteriosus (PDA), necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), feeding intolerance, and tachycardia. Due to data non-normality, non-parametric tests were utilized for mean comparisons and the chi-Square test for qualitative variables and relationships (P-value < 0.05). Results: The findings revealed no significant differences in hospital stay duration, time until separation from the device, Apgar scores at one and five minutes post-birth, or the incidence of PDA, NEC, BPD, and feeding intolerance between the two groups. However, the incidence of tachycardia was notably higher in the group receiving the higher caffeine dose (P-value = 0.026). Conclusions: While the incidence of tachycardia was significantly higher in infants receiving a maintenance dose of 10 mg/kg, there was no observed difference in the efficacy of the two caffeine doses. Therefore, a maintenance dose of 5 mg/kg of caffeine citrate emerges as a more favorable treatment option.
枸橼酸咖啡因维持剂量对新生儿重症监护室住院早产儿拔除气管插管和拔管后呼吸暂停的效果比较:随机临床试验
背景:呼吸窘迫是早产儿死亡和发病的主要原因之一,插管和机械通气是主要的积极治疗方法。枸橼酸咖啡因是一种广泛使用的甲基黄嘌呤,可治疗早产儿呼吸暂停。然而,高剂量咖啡因的疗效仍存在争议。研究目的本研究旨在评估维持剂量的枸橼酸咖啡因在促进气管插管拔除和减少新生儿重症监护室早产儿后续呼吸暂停发作方面的有效性和副作用。研究方法这项研究于 2023 年在伊朗克尔曼的阿夫扎利布尔医院进行,是一项随机临床试验,共有 80 名胎龄在 35 周以下的新生儿参与。他们被分为两组:一组接受初始剂量为 20 毫克/千克的枸橼酸咖啡因,随后每天维持 5 毫克/千克的剂量,直到婴儿拔管后至少 7 天没有呼吸暂停表现;另一组接受 10 毫克/千克的维持剂量。研究分析了胎龄、性别、体重以及出生后 1 分钟和 5 分钟的阿普加评分等变量。研究评估了枸橼酸咖啡因剂量在拔除气管插管和减少呼吸暂停事件方面的效果,次要结果包括动脉导管未闭(PDA)、坏死性小肠结肠炎(NEC)、支气管肺发育不良(BPD)、喂养不耐受和心动过速。由于数据非正态性,因此采用非参数检验进行均值比较,并采用卡方检验进行定性变量和关系的比较(P 值小于 0.05)。结果研究结果表明,两组产妇在住院时间、脱离设备时间、出生后 1 分钟和 5 分钟的 Apgar 评分、PDA、NEC、BPD 和喂养不耐受的发生率方面无明显差异。不过,咖啡因剂量较高的一组心动过速的发生率明显较高(P 值 = 0.026)。结论虽然接受 10 毫克/千克维持剂量的婴儿心动过速发生率明显较高,但观察到两种咖啡因剂量的疗效并无差异。因此,维持剂量为 5 毫克/千克的枸橼酸咖啡因是更有利的治疗方案。
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来源期刊
CiteScore
1.40
自引率
0.00%
发文量
26
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