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Caffeine therapy safe, effective for apnoea of prematurity

13 May 2018

Neonatal caffeine therapy shows promise in the management of apnoea of prematurity in very low birthweight neonates, according to a study. Specifically, it helps improve visuomotor, visuoperceptual and visuospatial abilities at age 11 years without compromising general intelligence, attention and behaviour.

The study randomly assigned 870 children with a birthweight of 500–1,250 g to treatment groups receiving caffeine (a loading dose of 20 mg of caffeine citrate per kilogram of body weight, followed by a daily maintenance dose of 5 mg/kg; n=432) or placebo (equivalent volume of normal saline; n=438). If apnoea persisted, caffeine therapy dose was escalated to a maximum of 10 mg/kg per day. Treatment was initiated at a median age of 3 days and weaned before reaching a median postmenstrual age of 35 weeks.

Outcomes of interest included general intelligence, attention, executive function, visuomotor integration and perception, and behaviour at 11 years of age. Results showed that these neurobehavioral outcomes were generally similar between the caffeine and placebo group.

However, caffeine yielded significantly greater improvements in fine motor coordination (mean difference [MD], 2.9; 95 percent CI, 0.7–5.1; p=0.01), visuomotor integration (MD, 1.8; 0.0–3.7; p<0.05), visual perception (MD, 2.0; 0.3–3.8; p=0.02) and visuospatial organization (MD, 1.2; 0.4–2.0; p=0.003).

None of the outcomes investigated were adversely affected by caffeine. This indicates the long-term safety and efficacy of caffeine therapy for apnoea of prematurity in very low birth weight neonates, as pointed out by researchers.

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