Objective: To compare the effects of early and routine initiation of caffeine in non-intubated preterm neonates.
Study Design: Twenty-one neonates 29 weeks gestational age were randomized to receive intravenous caffeine citrate (20 mg/kg) either before 2 hours of age (early) or at 12 hours of age (routine). Saline placebo was administered at 12 hours of age in the early group and before 2 hours of age in the routine group. The primary outcome was the need for endotracheal intubation by 12 hours of age. Other secondary outcomes included comparisons of cerebral oxygenation, systemic and pulmonary blood flow, hemodynamics, hypotension treatment, oxygen requirement, and head ultrasound findings.
Results: There was no difference in the need for intubation (early 27 vs late 70%, p=0.08), or vasopressors (0 vs 20%, p=0.21) by 12 hours of life. Early caffeine was associated with improved blood pressure (p=0.03) and systemic blood flow (p=0.04). Heart rate, left ventricular output, and stroke volume were not significantly affected by early caffeine. Cerebral oxygenation transiently decreased one hour after caffeine administration, returning to baseline by two hours after administration. There were no differences in other outcomes such as intraventricular hemorrhage and chronic lung disease.
Conclusions: This pilot study demonstrated that early caffeine administration of caffeine is associated with improved hemodynamics in extremely preterm neonates. Larger studies are needed to determine whether early caffeine reduces intubation, and on other outcomes such as chronic lung disease and neurodevelopmental impairment.