Extended caffeine treatment for apnoea in preemies offers little benefit

Continuation of caffeine treatment for apnoea in moderately preterm infants does not help shorten hospitalization, according to a study.

The study included 827 premature infants (median gestational age 31 weeks, 51 percent female) who were at 33 to 35 weeks of postmenstrual age and were receiving caffeine treatment for apnoea with plans to discontinue it. These infants were randomized to receive oral caffeine citrate (10 mg/kg/d) or placebo until 28 days after discharge. All of them were receiving full feeds (≥120 mL/kg/d).

Days to discharge after randomization were determined as the primary outcome. Secondary outcomes included days to physiological maturity (apnoea free for 5 consecutive days, receiving full oral feeds, and out of the incubator for at least 48 hours), postmenstrual age at discharge, all-cause hospital readmissions, all-cause sick and emergency department visits, safety outcomes, and death.

The duration of hospitalization was 18.0 days in the caffeine group vs 16.5 days in the placebo group, with the difference not reaching significance (adjusted median difference, 0 days, 95 percent confidence interval [CI], −1.7 to 1.7). Likewise, no significant between-group difference was seen in physiological maturity (14.0 vs 15.0 days; adjusted median difference, −1 day, 95 percent CI, −2.4 to 0.4).

Freedom from apnoea occurred sooner in the caffeine group than in the placebo group (6.0 vs 10.0 days; adjusted median difference, −2.7 days, 95 percent CI, −3.4 to −2.0), but the duration of full oral feeding was similar (7.5 vs 6.0 days; adjusted median difference, 0 days, 95 percent CI, −0.1 to 0.1). Rates of readmissions and sick visits were also comparable between the two groups.

The frequency of adverse events did not significantly differ between the caffeine and placebo groups.