292 - Apnea of Prematurity (AOP): Relationship of Discontinuation of Caffeine to Oral Feeding Ability

Caffeine has been a central component in the treatment of AOP in premature infants for decades; however, there is a lack of consensus on the appropriate timeline to discontinue treatment.

Objective:

We hypothesized that the duration of treatment with caffeine citrate has an association with attainment of feeding milestones. The purpose of this study was to analyze infants in our neonatal intensive care unit (NICU) who were started on caffeine for AOP and their post menstrual age (PMA) at which caffeine was discontinued relative to their per os (PO) intake. Our intent was to identify the ideal PMA at which caffeine could be discontinued safely, i.e. without significant apnea/bradycardia/desaturation episodes and/or necessitating re-introduction of caffeine within the week following its stoppage.

Design/Methods:

In this retrospective single center study, we included inborn infants with gestational age (GA) < 32 weeks and birth weight < 1500 g admitted to our NICU at The Children’s Regional Hospital at Cooper for babies born from January 1, 2012 - December 31, 2020. We excluded infants who did not survive to discharge, were transferred prior to caffeine discontinuation, or were never treated with caffeine therapy; infants with major cardio-pulmonary congenital malformations or genetic disorders, severe intraventricular hemorrhage or periventricular leukomalacia, or confirmed central nervous system infection. Data were collected via electronic medical records review from the pharmacy and medical databases.

Results:

Significantly different characteristics of those infants who required restart of caffeine are included in Table 1.

Those infants who were restarted on caffeine citrate within the 1 week following discontinuation had a significantly younger GA at birth and at initiation of caffeine (P=0.001), although there was no significant difference in their PMA at caffeine discontinuation (Table 1).

Infant feeding milestones, expressed as percentage of feeds taken PO, were not significantly different at the time of caffeine discontinuation between infants requiring restart of caffeine within the subsequent 1 week (n = 8) and those in whom caffeine was successfully discontinued (n = 174) (Table 2).

Conclusion(s):

Overall, the standard of care (discontinuation of caffeine at 34-36 weeks PMA) was followed in our NICU.  Though our sample size is small, we do not have evidence to support the use of percentage of feeds taken PO as an indicator of safe discontinuation of caffeine. Additional study is required to find surrogate markers of brain maturity to safely discontinue caffeine in our very preterm infants.