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  • Original Article
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Caffeine decreases intermittent hypoxia in preterm infants nearing term-equivalent age

Journal of Perinatology volume 37, pages 1135–1140 (2017)Cite this article

Subjects

Abstract

Objective:

To determine whether intermittent hypoxia (IH) persisting after 36 weeks postmenstrual age (PMA) can be attenuated using caffeine doses sufficient to maintain caffeine concentrations >20 μg ml−1.

Study Design:

Twenty-seven infants born <32 weeks were started on caffeine citrate at 10 mg kg−1 day−1 when clinical caffeine was discontinued. At 36 weeks PMA, the dose was increased to 14 or 20 mg kg−1 day−1 divided twice a day (BID) to compensate for progressively increasing caffeine metabolism. Caffeine concentrations were measured weekly. The extent of IH derived from continuous pulse oximetry was compared to data from 53 control infants.

Result:

The mean (s.d.) gestational age of enrolled infants was 27.9±2 weeks. Median caffeine levels were >20 μg ml−1 on study caffeine doses. IH was significantly attenuated through 38 weeks PMA compared with the control group.

Conclusion:

Caffeine doses of 14 to 20 mg kg−1 day−1 were sufficient to maintain caffeine concentrations >20 μg ml−1 and reduce IH in preterm infants at 36 to 38 weeks PMA.

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Acknowledgements

This study was supported in part by the American SIDS Institute (ASI), Naples, FL, USA. We thank Denis Rybin, PhD for his active participation in data analysis including statistical analysis; Robert Ward, MD for contributions to study design; Masimo Corporation, for providing the pulse oximeters; and Acumen Instruments Corporation for providing the serial data recorders.

Author information

Author notes

  1. L M Rhein

    Present address: 10Current address: Department of Pediatrics, University of Massachusetts Memorial Medical Center, Worcester, MA, USA.,

  2. E Eichenwald

    Present address: 11Current address: Department of Pediatrics, Perlman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,

  3. Additional members of The Caffeine Study Group are listed above References

Authors and Affiliations

  1. Department of Pediatrics, Uniformed Services University of Health Sciences, Bethesda, MD, USA

    N R Dobson & C E Hunt

  2. Department of Newborn Medicine and Respiratory Diseases, Boston Children’s Hospital, Boston, MA, USA

    L M Rhein

  3. Department of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA

    R A Darnall

  4. Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA

    M J Corwin

  5. Slone Epidemiology Center at Boston University, Boston, MA, USA

    M J Corwin

  6. Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA

    T C Heeren

  7. Department of Pediatrics, University of Texas Health Sciences Center, Children’s Memorial Hermann Hospital, Houston, TX, USA

    E Eichenwald

  8. Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children’s Research Institute, Little Rock, AR, USA

    L P James

  9. American SIDS Institute, Naples, FL, USA

    B L McEntire

Authors
  1. N R Dobson
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  2. L M Rhein
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  3. R A Darnall
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  4. M J Corwin
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  5. T C Heeren
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  6. E Eichenwald
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  7. L P James
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  8. B L McEntire
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  9. C E Hunt
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Consortia

The Caffeine Study Group

  • L Consenstein
  •  & R D White

Corresponding author

Correspondence to N R Dobson.

Ethics declarations

Competing interests

Dr McEntire is the Chief Executive Officer of the ASI, and Drs Hunt and Dobson are members of the ASI Board of Directors. The sponsor had no role in the analysis and interpretation of data. Dr McEntire participated in design and conduct of the study; collection of data; review of the manuscript; and the decision to submit the manuscript for publication. Drs Dobson, Hunt and Corwin have full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Dr Dobson wrote the first draft of the manuscript. Dr Rhein reports grants from PCORI and non-financial support from Masimo, outside the submitted work. Dr James is part owner of Acetaminophen Toxicity Diagnostics, LLC, which is funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) STTR/2R42DK079387, and she receives salary support for research from the National Center for Advancing Translational Sciences (NCATS) awarded to the Translational Research Institute at the University of Arkansas for Medical Sciences (UL1RR029884). The remaining authors declare no conflict of interest.

Additional information

This study was presented in part at Pediatric Academic Societies Annual Meeting, Baltimore, MD, USA (3 May 2016).

Disclaimer

The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Army, Department of Defense, nor the U.S. Government. Some authors are a military service member or a U.S. Government employee. This work was prepared as part of their official duties. Title 17 U.S.C. 105 provides that ‘Copyright protection under this title is not available for any work of the United States Government’. Title 17 U.S.C. 101 defines a United States Government work as a work prepared by a military service member or employee of the United States Government as part of that person’s official duties.

L Consenstein (Department of Pediatrics, St. Joseph’s Hospital Health Center, Syracuse, NY, USA) and RD White (Pediatrix Medical Group, Memorial Hospital, South Bend, IN, USA).

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Dobson, N., Rhein, L., Darnall, R. et al. Caffeine decreases intermittent hypoxia in preterm infants nearing term-equivalent age. J Perinatol 37, 1135–1140 (2017). https://doi.org/10.1038/jp.2017.82

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