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Administration time of caffeine in preterm infants: systematic review and meta-analysis

Journal of Perinatology (2024)Cite this article

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Abstract

To assess the ideal time for caffeine administration in preterms, identifying its effects and safety. Study Design: Meta-analysis conducted including preterms <32 weeks GA or BW < 1500 g, comparing caffeine administration time: <24 x ��24HOL, <48 x ≥48HOL, <72 x ≥72HOL. 18 studies included 76.998 patients. The median age of starting caffeine was the first 24 HOL. In the overall comparisons, there was reduction in patent ductus arteriosus (OR 0.71 [0.55, 0. 92]; low evidence), retinopathy of prematurity (OR 0.71 [0.54, 0.93]; moderate evidence), severe brain injury (OR 0.79 [0.70, 0.91]; moderate evidence), bronchopulmonary dysplasia (BPD) (OR 0.69 [0.59, 0.81]; moderate evidence), composite outcome of BPD or death (OR 0.76 [0.66, 0.88]; moderate evidence). Mortality increase was found (OR 1.20 [1.12, 1.29], very low evidence).Caffeine in the first 24 HOL has benefits in reducing morbidities associated with prematurity. Mortality finding is potentially due to survival bias.

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Fig. 1: Flowchart -Identification of sudies.
Fig. 2: Comparison of early caffeine versus late caffeine: retinopathy of prematurity and patent ductus arteriosus treatment.
Fig. 3: Comparison of early caffeine versus late caffeine: necrotizing enterocolitis and severe neurological injury.
Fig. 4: Comparison of early caffeine versus late caffeine: bronchopulmonary dysplasia and or death.
Fig. 5: Comparison of early caffeine versus late caffeine:mechanical ventilation.

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Data availability

The datasets generated during and analyzed during the current study are available from the corresponding author upon reasonable request.

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Author information

Authors and Affiliations

  1. Postgraduate Masters Degree in Program of Health of Child and Adolescent, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil

    Gabriela S. Trindade

  2. MD, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil

    Gabriela S. Trindade

  3. Postgraduate Program of Health of Child and Adolescent, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil

    Renato S. Procianoy

  4. Neonatology Section, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil

    Renato S. Procianoy & Rita C. Silveira

  5. Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil

    Victoria Baptista dos Santos

  6. Pediatric Department, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil

    Alícia Dorneles Dornelles

  7. Postgraduate Program of Health of Child and Adolescent and Pediatric Department, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil

    Rita C. Silveira

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Contributions

GST, RCS, RSP conceptualized and designed the study. GST and VBS conducted the search, screening, and study selection. RCS supervised data collection and resolved differences in study selection. GST performed the statistical analysis and drafted the initial manuscript. RCS, RSP, and ADD critically reviewed and revised the manuscript. GST, RCS, RSP and ADD were involved in the revisions of the manuscript. All authors agreed to the final draft of the manuscript being submitted and all authors discussed the results and approved the final manuscript.

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Correspondence to Rita C. Silveira.

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Trindade, G.S., Procianoy, R.S., dos Santos, V.B. et al. Administration time of caffeine in preterm infants: systematic review and meta-analysis. J Perinatol (2024). https://doi.org/10.1038/s41372-024-02042-x

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