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Neonatal Respiratory Assessment/Support/Ventilation

Neonatal Respiratory Assessment/Support/Ventilation 3: Physiology 2 and Clinical Outcomes

346 - Respiratory Response to Caffeine Cessation in Preterm Infants: A Pre-Post Observational Study

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 346
Publication Number: 346.346

Colm P. Travers, University of Alabama School of Medicine, Birmingham, AL, United States; Arie Nakhmani, University of Alabama at Birmingham, Birmingham, AL, United States; Samuel Gentle, University of Alabama at Birmingham, Birmingham, AL, United States; Rachel L. Benz, University of Alabama at Birmingham, Birmingham, AL, United States; Waldemar A. Carlo, University of Alabama School of Medicine, Birmingham, AL, United States; Namasivayam Ambalavanan, University of Alabama School of Medicine, Birmingham, AL, United States

Presenting Author(s)

Colm P. Travers, MD

Assistant professor
University of Alabama School of Medicine
Birmingham, Alabama, United States

Background: Caffeine is used in preterm infants to reduce the adverse effects of apnea of prematurity. Caffeine cessation for 5-7 days before discharge is done to ensure infants remain apnea free after drug washout.

Objective: To test the hypothesis that cessation of caffeine will be associated with increased episodes of bradycardia and intermittent hypoxemia (IH) resulting from apnea in the 14 days after cessation compared with the 14 days before cessation.

Design/Methods: This single center observational study included infants from 22-28 weeks’ gestation enrolled in the PreVENT study (NCT03174301). We excluded infants who died or who discontinued caffeine while on respiratory support including mechanical ventilation or continuous positive airway pressure. Numeric vital sign data at 1Hz were collected directly from patient monitors in the 14 days before and the 14 days after clinically indicated caffeine cessation. Per unit practice, caffeine was discontinued when infants were off positive pressure support and had completed 5 days without a clinically significant bradycardia defined as < 100 bpm for ≥ 10 seconds or hypoxemia < 80% for ≥ 10 seconds. Infant characteristics and outcome data were collected daily prospectively from the electronic medical record. The primary outcome was the difference in episodes of IH per hour, defined as oxygen saturations < 85% for ≥10 seconds, after caffeine cessation. Secondary outcomes included IH < 80% for ≥10 seconds and bradycardia episodes < 100bpm and < 80 bpm for ≥10 seconds. Data were analyzed by generalized linear models with repeated measures and a p< 0.05 was considered significant.

Results: There were 263 infants in the cohort of whom 44 met exclusion criteria and 67 had missing data. Among the 152 infants included, the mean (SD) gestational age was 25w 5d (13d) and birth weight was 829 (276) grams. Caffeine was discontinued at a median postmenstrual age of 35w 4d (15d). Caffeine cessation was associated with increased episodes of IH (p< 0.001). Episodes of IH and bradycardia of different depths and duration increased after caffeine cessation [Figure 1]. The increase in episodes occurred primarily in the 5-7 days after caffeine cessation.

Conclusion(s): Intermittent hypoxemia and bradycardia episodes among extremely preterm infants increased after caffeine cessation. These data agree with current guidelines from professional societies to monitor infants for the 5-7 days before discharge after caffeine cessation.