Association of caffeine with renal and other short-term outcomes in neonates with hypoxic-ischaemic encephalopathy undergoing therapeutic hypothermia.

IF 2.3 4区 医学 Q2 PEDIATRICS
Rakesh Lavu, Nicholas Nicoletti, Sarah Worley, Subhash Puthuraya, Hany Aly, Ceyda Acun
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Abstract

Objective: To evaluate the association of caffeine with renal and other short-term clinical outcomes in neonates with moderate or severe hypoxic-ischaemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH).

Study design: This retrospective cohort study included neonates born at ≥36 weeks gestational age with moderate or severe HIE treated with TH at our centre between January 2013 and December 2022. In 2019, there was a practice change to administer a single intravenous 20 mg/kg caffeine citrate dose for moderate/severe HIE, forming two cohorts (non-caffeine vs caffeine). The primary outcome was acute kidney injury (AKI), defined by modified Kidney Disease: Improving Global Outcomes criteria. Secondary outcomes included daily serum creatinine, blood-urea nitrogen (BUN), urine output, HIE-pattern lesion on brain-MRI, early EEG background grade, seizures, duration of mechanical ventilation, length of stay, tube-feeding at discharge and in-hospital mortality.

Results: 85 neonates met the inclusion criteria; 38 received caffeine, and 47 did not. AKI incidence was lower in the caffeine group (29% vs 47%), although not statistically significant (p=0.09). BUN levels and serum creatinine levels were significantly lower in the caffeine group on days 3-5 (p<0.05). MRI abnormalities consistent with HIE were more frequent in the caffeine group (60% vs 36%, p=0.028), particularly in infants with moderate HIE (p=0.004). EEG background profiles differed, with caffeine-exposed neonates displaying fewer severe (34% vs 65%) and more mild-to-moderate patterns. No significant differences were noted in other secondary outcomes.

Conclusion: Caffeine during TH lowered serum creatinine and BUN but did not significantly reduce AKI and was associated with higher rates of MRI lesions. Prospective, dose-controlled trials with pharmacokinetic monitoring and long-term neurodevelopmental follow-up are needed to clarify caffeine's renal benefits and neurological safety in neonatal HIE.

治疗性低温治疗的低氧缺血性脑病新生儿咖啡因与肾脏和其他短期预后的关系
目的:评价咖啡因与接受低温治疗的中度或重度缺氧缺血性脑病(HIE)新生儿肾脏及其他短期临床预后的关系。研究设计:本回顾性队列研究纳入2013年1月至2022年12月在本中心接受TH治疗的≥36孕周的中度或重度HIE新生儿。2019年,对中度/重度HIE进行了一次静脉注射20 mg/kg枸橼酸咖啡因的做法改变,形成了两个队列(非咖啡因和咖啡因)。主要结局是急性肾损伤(AKI),由修改后的肾脏疾病:改进的全球结局标准定义。次要结局包括每日血清肌酐、血尿素氮(BUN)、尿量、脑mri hie型病变、早期脑电图背景分级、癫痫发作、机械通气持续时间、住院时间、出院时管饲和住院死亡率。结果:85例新生儿符合纳入标准;38人摄入了咖啡因,47人没有。咖啡因组AKI发生率较低(29% vs 47%),但无统计学意义(p=0.09)。在第3-5天,咖啡因组的BUN水平和血清肌酐水平显著降低(p结论:TH期间咖啡因降低了血清肌酐和BUN,但没有显著降低AKI,并与较高的MRI病变率相关。需要前瞻性、剂量对照试验、药代动力学监测和长期神经发育随访来阐明咖啡因对新生儿HIE的肾脏益处和神经安全性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMJ Paediatrics Open
BMJ Paediatrics Open Medicine-Pediatrics, Perinatology and Child Health
CiteScore
4.10
自引率
3.80%
发文量
124
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