Search

Purpose: To investigate the physicochemical compatibility of caffeine citrate and caffeine base injections with 43 secondary intravenous (IV) drugs used in Neonatal Intensive Care Unit (NICU) settings. Methods: Caffeine citrate (20 mg/mL or 10 mg/mL) or caffeine base injection (10 mg/mL) were mixed in a volume ratio of 1:1 with the secondary drug solution to simulate Y-site co-administration procedures in NICUs. Physical compatibility was evaluated based on visual observation for 2 h, against a black and white background and under polarised light, for changes in colour, precipitation, haze and evolution of gas. Chemical compatibility was determined from caffeine concentration measurements, using a validated high-performance liquid chromatography assay. Results: Six of the 43 secondary drugs tested (aciclovir, amphotericin (liposomal), furosemide, hydrocortisone, ibuprofen and ibuprofen lysine) were physically incompatible with caffeine citrate undiluted injection (20 mg/mL), at their high-end, clinically relevant concentrations for NICU settings. However, when tested at lower concentrations, hydrocortisone (1 mg/mL) was physicochemically compatible, whereas furosemide (0.2 mg/mL) was physically incompatible with caffeine citrate. The six drugs which showed physical incompatibility with caffeine citrate 20 mg/mL injection were also physically incompatible with caffeine citrate 10 mg/mL solution. All 43 secondary drugs tested were physicochemically compatible with caffeine base injection. Conclusions: Most secondary test drugs, except aciclovir, amphotericin (liposomal), furosemide, hydrocortisone, ibuprofen and ibuprofen lysine, were physicochemically compatible with caffeine citrate injection. Caffeine base injection was physicochemically compatible with all 43 test drugs tested. [ABSTRACT FROM AUTHOR]

Abstract Background With a wide therapeutic index, efficacy, ease of use, and other neuroprotective and respiratory benefits, caffeine citrate(CC) is currently the drug of choice for preterm neonates (PTNs). Caffeine-induced excessive energy expenditure, diuresis, natriuresis, and other CC-associated potential side-effects (CC-APSEs) result in lower daily-weight gain (WG) in premature neonates. This study aimed to evaluate the risk factors for daily-WG in neonates exposed to different dose regimens of caffeine in ICU. Method This retrospective cohort study included neonates of ≤ 36weeks gestational age (GA) and received CC-therapy. The same participants were followed for data analysis in two postnatal phases: 15–28 and 29–42 days of life (DOL). Based on daily CC-dose, formed group-I (received; standard-doses = 5 mg/kg/day), group-II (received;>5-7 mg/kg/day), and group-III (received;>7 mg/kg/day). Prenatal and postnatal clinical characteristics, CC-regimen, daily-WG, CC-APSEs, and concomitant risk-factors, including daily-caloric intake, Parenteral-Nutrition duration, steroids, diuretics, and ibuprofen exposure, were analyzed separately for group-II and group-III using group-I as standard. Regression analysis was performed to evaluate the risk factors for daily-WG. Results Included 314 PTNs. During 15–28 DOL, the mean-daily-WG(MD-WG) was significantly higher in group-I than group-II [19.9 ± 0.70 g/kg/d vs. 17.7 ± 0.52 p = 0.036] and group-III [19.9 ± 0.70 g/kg/d vs. 16.8 ± 0.73 p 7-10 mg/kg/day (β=-1.36; 95%CI:-1.56,-1.02) were associated with a lower daily-WG. However, during 29-42DOL, this association was present only for > 7-10 mg/kg/day (β=-1.54; 95%CI:-1.66,-1.42). The GA ≤ 27weeks (β=-1.03 95%CI:-1.24, -0.88) was associated with lower daily-WG only during 15-28DOL. During both periods of therapy, higher cumulative-caffeine dose and presence of culture proven sepsis, tachypnea, hyponatremia, and feeding intolerance were significantly associated with lower daily-WG. Conversely, daily kcal intake was found to be linked with an increase in daily-WG in both periods. Conclusion In this study cohort exposure to higher caffeine daily and cumulative doses is associated with lower postnatal daily-WG in PTNs than standard-daily doses, which may be due to its catabolic effects and CC-APSEs.

Background: With a wide therapeutic index, efficacy, ease of use, and other neuroprotective and respiratory benefits, caffeine citrate(CC) is currently the drug of choice for preterm neonates (PTNs). Caffeine-induced excessive energy expenditure, diuresis, natriuresis, and other CC-associated potential side-effects (CC-APSEs) result in lower daily-weight gain (WG) in premature neonates. This study aimed to evaluate the risk factors for daily-WG in neonates exposed to different dose regimens of caffeine in ICU. Method: This retrospective cohort study included neonates of ≤ 36weeks gestational age (GA) and received CC-therapy. The same participants were followed for data analysis in two postnatal phases: 15–28 and 29–42 days of life (DOL). Based on daily CC-dose, formed group-I (received; standard-doses = 5 mg/kg/day), group-II (received;>5-7 mg/kg/day), and group-III (received;>7 mg/kg/day). Prenatal and postnatal clinical characteristics, CC-regimen, daily-WG, CC-APSEs, and concomitant risk-factors, including daily-caloric intake, Parenteral-Nutrition duration, steroids, diuretics, and ibuprofen exposure, were analyzed separately for group-II and group-III using group-I as standard. Regression analysis was performed to evaluate the risk factors for daily-WG. Results: Included 314 PTNs. During 15–28 DOL, the mean-daily-WG(MD-WG) was significantly higher in group-I than group-II [19.9 ± 0.70 g/kg/d vs. 17.7 ± 0.52 p = 0.036] and group-III [19.9 ± 0.70 g/kg/d vs. 16.8 ± 0.73 p < 0.001]. During 29–42 DOL the MD-WG of group-I was only significantly higher than group-III [21.7 ± 0.44 g/kg/d vs. 18.3 ± 0.41 g/kg/d p = 0.003] and comparable with group-II. During 15–28 DOL, observed CC-APSEs was significantly higher in group-II and III but during 29–42 DOL it was only significant in group-III. In the adjusted regression analysis for daily-WG during 15-28DOL, with respect to standard-dose, 5-7 mg/kg/day (β=-1.04; 95%CI:-1.62,-0.93) and > 7-10 mg/kg/day (β=-1.36; 95%CI:-1.56,-1.02) were associated with a lower daily-WG. However, during 29-42DOL, this association was present only for > 7-10 mg/kg/day (β=-1.54; 95%CI:-1.66,-1.42). The GA ≤ 27weeks (β=-1.03 95%CI:-1.24, -0.88) was associated with lower daily-WG only during 15-28DOL. During both periods of therapy, higher cumulative-caffeine dose and presence of culture proven sepsis, tachypnea, hyponatremia, and feeding intolerance were significantly associated with lower daily-WG. Conversely, daily kcal intake was found to be linked with an increase in daily-WG in both periods. Conclusion: In this study cohort exposure to higher caffeine daily and cumulative doses is associated with lower postnatal daily-WG in PTNs than standard-daily doses, which may be due to its catabolic effects and CC-APSEs. [ABSTRACT FROM AUTHOR]

The article focuses on the impact of maintenance doses of caffeine citrate on tracheal tube removal and apnea reduction in premature infants in neonatal intensive care units. It reports that while tachycardia incidence was higher with maintenance doses, both low and high doses showed similar efficacy, suggesting a potential preference for using maintenance doses as a treatment option.

Background: Caffeine citrate (CC)-induced excessive energy expenditure, diuresis, natriuresis, and other CC-associated potential side effects (CC-APSEs) result in lower daily weight gain (WG) in premature neonates. This study aimed to assess higher CC-doses' effect on the mean daily-WG (MD-WG) and CC-APSE development, considering 5 mg/kg/day as the standard regimen. Method: This retrospective cohort study included neonates of ≤36 weeks gestational age and received CC-therapy. The same participants were followed for data analysis in two postnatal phases: 15–28 and 29–42 days of life (DOL). Based on daily CC-dose, formed group-I=(5 mg/kg/day), group-II=(>5–7 mg/kg/day), and group-III=(>7 mg/kg/day). Data was analyzed separately for group-II and group-III using group-I as the standard. Results: The study included 284 neonates. During phase-I, the MD-WG was significantly higher in group-I than group-II (19.9 ±.88 g/kg/d vs 17.5 ±.49, P =.031) and group-III (19.9 ±.88 g/kg/d vs 16.7 ±.71, P <.001). During 29–42 DOL, the MD-WG of group-I was only significantly higher than group-III (21.5 ±.42 g/kg/d vs 18.1 ±.39 g/kg/d, P =.003) and comparable with group-II. During 15–28 DOL, CC-APSEs were significantly higher in group-II and group-III but during 29–42 DOL was significant only in group-III. Conclusion: Exposure to higher caffeine doses in this study cohort is associated with lower postnatal WG in preterm neonates than standard daily doses may be due to its catabolic effects and CC-APSEs. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To explore the effectiveness of the early application of caffeine citrate combined with vitamin A and vitamin D in the prevention of broncho-pulmonary dysplasia (BPD) in preterm infants. METHODS: A total of 105 premature infants admitted into this hospital from Dec. 2021 to Jun. 2023 were retrospectively selected to be divided into the convention group (conventional treatment, 50 cases) and prevention group (conventional treatment + caffeine citrate combined with vitamin A and vitamin D for prevention, 55 cases) according to different postpartum treatment. The occurrence and grading of BPD were compared between two groups and the changes of illness condition were closely observed, the incidences of intracranial hemorrhage (ICH), periventricular leukomalacia (PVL), sepsis and retinopathy (ROP) were compared, the duration of ventilator use and oxygen uptake, recovery time of birth weight and length of hospital stay of the two groups were recorded and compared. After 48 h of treatment, the indicators of arterial blood gas analysis including pH, arterial partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2), oxygenation index (OI) and fraction of inspired oxygen (FiO2) levels of both groups were observed; the changes of inflammatory indicators of tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6) levels were compared between two groups before and after treatment. RESULTS: The incidence of BPD was significantly lower and the proportion of mild BPD was significantly higher in the prevention group than those in the convention group, with statistically significant differences (P <0. 05). There were no statistically significant differences in the incidence of hypertension, pneumothorax, necrotizing enterocolitis, hyperglycemia, patent ductus arteriosus, intracranial hemorrhage, and sepsis between the control group and the prevention group in premature infants (P >0. 05). The duration of ventilator use and oxygen uptake, recovery time of birth weight and length of hospital stay of the prevention group after treatment were significantly shorter than those of the convention group, with statistically significant differences (P<0. 05). The PaO2 and OI levels were significantly higher, the PaCO2 and FiO2 were significantly lower in the prevention group than those in the convention group, with statistically significant differences (P<0. 05). After treatment, the serum TNF-α and IL-6 levels of both groups had been significantly decreased compared to before treatment, and that of the prevention group was significantly lower than the convention group, with statistically significant difference (P<0. 05). CONCLUSIONS: The early application of caffeine citrate combined with vitamin A and vitamin D can prevent the occurrence of BPD and reduce the severity of BPD, its mechanism may related to improving respiratory function and reducing body inflammation in preterm infants. In addition, early application of caffeine citrate combined with vitamins A and vitamin D may also reduce other complications such as ICH, PVL, sepsis and ROP, which is helpful to improve the prognosis of preterm infants. [ABSTRACT FROM AUTHOR]

Acute kidney injury (AKI) in neonates is associated with increased morbidity and mortality. Theophylline (a methylxanthine) has been shown to prevent neonatal AKI but is seldom used due to its unfavorable profile. Caffeine, another methylxanthine, is utilized ubiquitously to treat apnea of prematurity, but there are no randomized trials evaluating its efficacy in preventing neonatal AKI. This literature review aims to summarize the existing research pertaining to the relationship between caffeine and neonatal AKI. The review was conducted using Pubmed, Embase, Google Scholar, and Cochrane. Inclusion criteria incorporated empirical studies, being published in English, and being available electronically. All eight studies identified were included. Seven studies found caffeine-exposed premature neonates had lower rates of AKI than caffeine-unexposed neonates. Four found reduced AKI severity with caffeine exposure. One study included term neonates and did not find a difference in the AKI rate between caffeine-exposed and non-exposed babies. Limitations include exclusively observational studies, short study periods, heterogenous definitions of prematurity, and a lack of assessment of dose–effect relationships. In conclusion, premature neonates exposed to caffeine appear to have lower rates and potentially less severe AKI. Further research is needed before caffeine can be considered for use in the primary prevention of neonatal AKI. [ABSTRACT FROM AUTHOR]

Caffeine has a multitude of uses in anaesthesia, and numerous studies have evaluated its efficacy and usefulness in various aspects of anaesthesia and medical practice. Its various applications in anaesthesia include its role in awakening from anaesthesia, managing post-dural puncture headache, managing post-sedation paradoxical hyper-activity in children, post-operative bowel paralysis, and apnoea in paediatric populations, that is, apnoea in infancy, paediatric obstructive apnoea, and post-anaesthetic apnoea in pre-mature infants. Though the effects of caffeine on bronchial smooth muscle, neurological, and cardio-vascular systems are well known, the relatively little-known effects on the endocrine and gastro-intestinal (GI) system have been recently taking primacy for eliciting its therapeutic benefits. The literature shows encouraging evidence in favour of caffeine, but unambiguous evidence of caffeine benefits for patients is lacking and needs further investigation. In this narrative review of literature, we summarise the available literature to provide insights into the pharmacokinetics, pharmacodynamics, clinical application of caffeine in modern anaesthetic practice, and evidence available in this field to date. An awareness of the various physiological effects, adverse effects, reported applications, and their evidence will widen the horizon for anaesthesiologists to increase its rational use and advance research in this field. Well-designed randomised controlled trials regarding the various outcomes related to caffeine use in anaesthesia should be planned to generate sound evidence and formulate recommendations to guide clinicians. [ABSTRACT FROM AUTHOR]

We have investigated the efficacy and safety of different maintenance doses of caffeine citrate in the treatment of primary apnea in preterm infants. To this end, apneic premature infants were treated with 5 mg/kg (low dose) or 10 mg/kg (high dose) caffeine citrate, and the frequency of apnea at 48 h and 72 h, improvement of clinical symptoms, respiratory mechanics parameters related to lung function, and blood gas analysis indexes were compared between the two groups, and safety was evaluated. The frequency of apnea at 48 h and 72 h was significantly lower in the high-dose group than in the low-dose group, and the difference was statistically significant (P < 0.05). The time to resolution of apnea, the time to mechanical ventilation, and the time to citrate use were significantly shorter in the high-dose group than in the low-dose group (P < 0.05). The tidal volume and peak expiratory flow values were significantly higher in the high-dose group than in the low-dose group (P < 0.05). The oxygen partial pressure and pulse oximetry levels in the blood gas analysis indexes of the high-dose group were significantly higher than those of the low-dose group, and the partial pressure of carbon dioxide level was significantly lower than that of the low-dose group, with statistically significant differences (P < 0.05). The safety evaluation results showed no significant difference in the rate of adverse reactions and short-term complications between the high-dose group and the low-dose group (P > 0.05). Caffeine citrate at a maintenance dose of 10 mg/kg can effectively reduce the frequency of apnea, shorten the improvement time of clinical symptoms, and improve the lung function and blood gas analysis level of children with a high safety profile. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To probe into the effects of caffeine citrate combined with different doses of vitamin d on incidence and inflammatory reaction of bronchopulmonary dysplasia in preterm infants. METHODS: Totally 98 preterm infants admitted into the hospital from Jul. 2020 to Jun. 2022 were extracted to be divided into the study group and the observation group via the random number table method, with 49 cases in each group. Both groups were given routine treatment and caffeine citrate treatment. On this basis, the control group was treated with low-dose vitamin D, and the study group received high-dose vitamin D. Incidence of bronchopulmonary dysplasia and inflammatory factors [tumor necrosis factor α ( TNF-α ), interleukin-6 ( IL-6 ), endothelin-1 ( ET-1 ) and transforming growth factor-β1 (TGF-β1)], pulmonary function indicators [tidal volume ( TV), time to peak ratio ( TPTE / TE) and peak volume ratio (VPTE / VE)] of two groups were compared. The recovery of children was observed, and the main complications and adverse drug reactions were compared between two groups. RESULTS: The incidence of bronchopulmonary dysplasia in the study group was 8. 16% (4 / 49), lower than 24. 49% (12 / 49) in the control group, the difference was statistically significant (P<0. 05). After intervention, the levels of TNF-α, IL-6, ET-1 and TGF-β1 in the study group were significantly lower than those in the control group, with statistically significant difference (P<0. 05). After intervention, the levels of TV, TPTE / TE, VPTE / VE in the study group were significantly higher than those in the control group, with statistically significant difference (P<0. 05). The duration and disappearance time of apnea in the study group were significantly shorter than that of the control group, the times of apnea were significantly less than that of the control group, and the duration of invasive and non-invasive ventilation, length of stay, oxygen dependence time, and the time to regain birth weight were significantly shorter than that of the control group, the differences were statistically significant (P< 0. 05). There was no significant difference in the incidence of major complications and adverse drug reactions between two groups (P > 0. 05). CONCLUSIONS: Caffeine citrate combined with high-dose vitamin D can effectively reduce the incidence of bronchopulmonary dysplasia in premature infants, inhibit inflammatory reaction, improve lung function, shorten the time of oxygen dependence and mechanical ventilation, and have a positive impact on promoting the early recovery of airway in children, with higher safety. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the efficacy of caffeine citrate when combined with mechanical ventilation in the treatment of apnea of prematurity and its influence on neurodevelopmental outcomes. Methods: One hundred and sixty (160) premature infants with apnea admitted in Guangdong Second Provincial General Hospital, Guangzhou, China were enrolled in this study, and divided into control and study groups. Children in the control group underwent mechanical ventilation combined with aminophylline therapy, while children in the study group were administered mechanical ventilation combined with caffeine citrate. Blood gas and pulmonary function indices, as well as clinical symptom and neurodevelopmental improvements were assessed. Also, the incidence of adverse reactions were recorded during treatment. Results: Blood gas indices including oxygen partial pressure (PaO2) and pulse oxygen saturation (SPO2) levels in the study group were significantly higher, but partial pressure of carbon dioxide (PaCO2) level was lower (p < 0.05); furthermore, tidal volume, respiratory rate and peak expiratory flow (PEF) in the study group were higher than in the control group (p < 0.05). On the other hand, the disappearance time of apnea, invasive mechanical ventilation time and oxygen inhalation time in the study group were shorter than in the control group (p < 0.05). Mental development index (MDI) and psychomotor development index (PDI) values in the study group were significantly higher than in the control group (p < 0.05), while the incidence of bronchopulmonary dysplasia, feeding intolerance, tachycardia and hyperglycemia in the study group was significantly lower than in the control group (p < 0.05). Conclusion: The combination of caffeine citrate and mechanical ventilation aids improvement in the neurodevelopmental outcome of children, as well as reduction in the incidence of adverse reactions. However, further clinical trials are required prior to application of this strategy in clinical practice. [ABSTRACT FROM AUTHOR]

Caffeine has a multitude of uses in anaesthesia, and numerous studies have evaluated its efficacy and usefulness in various aspects of anaesthesia and medical practice. Its various applications in anaesthesia include its role in awakening from anaesthesia, managing post-dural puncture headache, managing post-sedation paradoxical hyper-activity in children, post-operative bowel paralysis, and apnoea in paediatric populations, that is, apnoea in infancy, paediatric obstructive apnoea, and post-anaesthetic apnoea in pre-mature infants. Though the effects of caffeine on bronchial smooth muscle, neurological, and cardio-vascular systems are well known, the relatively little-known effects on the endocrine and gastro-intestinal (GI) system have been recently taking primacy for eliciting its therapeutic benefits. The literature shows encouraging evidence in favour of caffeine, but unambiguous evidence of caffeine benefits for patients is lacking and needs further investigation. In this narrative review of literature, we summarise the available literature to provide insights into the pharmacokinetics, pharmacodynamics, clinical application of caffeine in modern anaesthetic practice, and evidence available in this field to date. An awareness of the various physiological effects, adverse effects, reported applications, and their evidence will widen the horizon for anaesthesiologists to increase its rational use and advance research in this field. Well-designed randomised controlled trials regarding the various outcomes related to caffeine use in anaesthesia should be planned to generate sound evidence and formulate recommendations to guide clinicians.

Acute kidney injury (AKI) in neonates is associated with increased morbidity and mortality. Theophylline (a methylxanthine) has been shown to prevent neonatal AKI but is seldom used due to its unfavorable profile. Caffeine, another methylxanthine, is utilized ubiquitously to treat apnea of prematurity, but there are no randomized trials evaluating its efficacy in preventing neonatal AKI. This literature review aims to summarize the existing research pertaining to the relationship between caffeine and neonatal AKI. The review was conducted using Pubmed, Embase, Google Scholar, and Cochrane. Inclusion criteria incorporated empirical studies, being published in English, and being available electronically. All eight studies identified were included. Seven studies found caffeine-exposed premature neonates had lower rates of AKI than caffeine-unexposed neonates. Four found reduced AKI severity with caffeine exposure. One study included term neonates and did not find a difference in the AKI rate between caffeine-exposed and non-exposed babies. Limitations include exclusively observational studies, short study periods, heterogenous definitions of prematurity, and a lack of assessment of dose–effect relationships. In conclusion, premature neonates exposed to caffeine appear to have lower rates and potentially less severe AKI. Further research is needed before caffeine can be considered for use in the primary prevention of neonatal AKI.

This study was aimed to investigate the mechanism of continuous positive airway pressure (CPAP) combined with caffeine citrate and aminophylline in the treatment of premature infants with apnea. in present study, sixty premature SD mice were randomly divided into blank control group (n = 20), intermittent hypoxia group (n = 20) and drug administration group (n = 20). Establishment of intermittent hypoxia model: the oxygen concentration in the cabin of mice in intermittent hypoxia group was maintained at 40%, then decreased to 10% and maintained for 3 min. After that, it was continuously increased to 40%, and was decreased to hypoxia after 8 min. The operation was repeated 3 times every 3h. The drug administration group was treated with continuous CPAP during modeling. The expressions of malondialdehyde (MDA), superoxide dismutase (SOD) and prostaglandin (PGE) in lower respiratory tract were detected by the kit; the expressions of protein kinase B (Akt), Bax and Bcl-2 were detected by Western blot. According to our findings after drug treatment, the body weight and respiratory ventilation of mice returned to normal level compared with the intermittent hypoxia group. Compared with the blank control group, after intermittent hypoxia, the contents of MDA, SOD and PGE in the lower respiratory tract of SD mice were significantly lower than those in the normal air group (P<0.05); after the premature mice were treated with drugs, the contents of MDA, SOD and PGE in the lower respiratory tract of SD mice were almost normal compared with those in the intermittent hypoxia group. RT-PCR results showed that compared with the blank control group, the expression of VEGF gene in the lower respiratory tract of SD mice increased after intermittent hypoxia (P<0.05). WB results showed that compared with the blank control group, the expressions of Akt and Bax protein in the lower respiratory tract of SD mice in intermittent hypoxia group were increased. The expression of Bcl-2 was decreased, and the difference was statistically significant (P<0.05). for conclusion, CPAP combined with caffeine citrate and aminophylline could improve the expressions of Akt, Bax and bcl-2 protein to treat premature infants with apnea. [ABSTRACT FROM AUTHOR]

To investigate the effect of caffeine citrate combined with positive pressure ventilation on ferritin and Clara cell secretory protein in neonatal respiratory distress. 82 cases of neonatal respiratory distress in our hospital from January 2016 to January 2021 were selected as the research object, all children need mechanical ventilation treatment, all children were randomly divided into observation group and control group, 41 cases in each group. The control group was treated with noninvasive positive pressure ventilation, and the control group was treated with caffeine citrate combined with noninvasive positive pressure ventilation. The hospitalization time, oxygen supply time and mechanical ventilation time, respiratory function index and blood gas index before and after treatment, SF and SF before and after treatment were compared between the two groups The expression level of CC16 and the adverse drug reactions and complications of the two groups during treatment. The hospitalization time, oxygen time and mechanical ventilation time of the observation group were significantly lower than those of the control group (P<0.05); There was no significant difference in the expression levels of P / F value, PaO2, PaCO2 and pH value between the two groups before treatment (P>0.05). After 24 hours of treatment, there was no significant difference in the pH value between the two groups (P>0.05). Compared with the control group, the P/F value and PaO2 level of the observation group increased significantly, and the PaCO2 level decreased significantly (P＜ 0.05); There was no significant difference in the expression levels of SF and CC16 between the two groups before treatment (P>0.05). After treatment, the levels of SF and CC16 in the two groups were decreased, and the observation group was significantly lower than the control group (P>0.05); A total of 11 cases of complications and adverse reactions occurred in the observation group, the incidence was 26.83, which was significantly lower than the 22 cases (53.66%) in the control group (P＜0.05). Caffeine citrate combined with positive pressure ventilation is better than single positive pressure ventilation in the treatment of neonatal respiratory distress, which can shorten the hospitalization time and ventilation time, reduce the pressure of family members, improve the oxygenation efficiency and blood gas index, improve the level of ferritin and Clara cell secreted protein, reduce the incidence of complications, and has good safety, It is worthy of clinical application and promotion. [ABSTRACT FROM AUTHOR]

To observe the effects of caffeine citrate combined with heating and humidifying high flow nasal catheter ventilation (HHHFNC) on neural development, serum bone morphogenetic protein-7 (BMP-7) and Clara cell secretory protein (CC16) in premature infants with respiratory distress syndrome (RDS). 93 premature infants with RDS who were treated in neonatal intensive care unit of our hospital from March 2019 to March 2021 were included. The children were randomly divided into control group [treated with nasal continuous positive airway pressure (nCPAP)] and experimental group (treated with caffeine citrate combined with HHHFNC), the number of cases were 46 and 47 respectively. The noninvasive auxiliary ventilation time, total oxygen consumption time, weaning failure rate, blood gas analysis index, neurodevelopment index, BMP-7, CC16 levels and complications were compared between the two groups. The time of noninvasive auxiliary ventilation and total oxygen consumption in the experimental group were shorter than those in the control group, and the failure rate of weaning was lower than that in the control group (P<0.05). There was no significant difference in pH between the two groups 24 hours after treatment (P>0.05). 24 hours after treatment, the partial pressure of blood oxygen (PaO2) in the experimental group was higher than that in the control group, and the partial pressure of carbon dioxide (PaCO2) was lower than that in the control group (P<0.05). After treatment, the psychomotor development index (PDI) and intellectual development index (MDI) in the experimental group were higher than those in the control group, 茁- Endorphins （茁-EP) was lower than that in the control group (P<0.05). After treatment, the levels of serum BMP-7 and CC16 in the experimental group were lower than those in the control group (P<0.05). There was no significant difference in the incidence of complications between the two groups(P>0.05). Caffeine citrate combined with HHHFNC in the treatment of RDS in preterm infants can shorten the time of noninvasive auxiliary ventilation, improve the success rate of weaning, promote the recovery of oxygenation, improve the levels of serum BMP-7 and CC16, and promote the neural development of children. [ABSTRACT FROM AUTHOR]

Introduction: Caffeine citrate is widely used for prevention of apnea of prematurity and helps in successful extubation from mechanical ventilation. The optimum caffeine dose in preterm infants with apnea of prematurity has been extensively investigated with varied results. The objective of our study was to compare the efficacy and safety of once versus twice daily maintenance dose of caffeine citrate in premature infants with apnea. Methods: In this study, preterm neonates with gestational age of 28 to 34 weeks, with evidence of apnea of prematurity were included. Both groups received a 20 mg / kg loading dose of caffeine citrate followed by a maintenance dose of 2.5 mg / kg every 12-hour-interval in group 1 and 5 mg / kg every 24-hour-interval in group 2, either orally or by intravenous infusion. Response to treatment, duration to achieve full feeds, possible adverse reactions were evaluated and compared among the two groups. Results: Among two groups, group 1 had early reduction in number of apneic episodes on five consecutive days after loading dose, which was statistically significant. Time taken to establish full feeds following treatment initiation was lower in group 1 compared to group 2 (median: Two vs four days) which was statistically significant. Conclusions: In this study, neonates who received twice daily maintenance dose of caffeine citrate had better outcomes in terms of early reduction in number of apneic episodes and early feed establishment when compared to those receiving once daily maintenance dose of caffeine citrate. [ABSTRACT FROM AUTHOR]

A clinical trial is currently underway to examine the efficacy of using caffeine citrate to prevent intermittent hypoxemia in late preterm neonates. Determining caffeine concentration using saliva in this population would be preferable as it is less invasive than plasma sampling, but a suitable method of analysis is required. This paper presents the development and validation of a rapid, efficient and reproducible stability-indicating high-performance liquid chromatography (HPLC) method and extraction protocol for the quantification of caffeine present in saliva. The stability of extemporaneously prepared caffeine citrate solutions (at 20–25 °C) was determined, along with the stability of caffeine spiked saliva samples (at 20–25 and 2–8 °C), to ensure the suitability of the developed method in the analysis of clinical trial samples. Protein precipitation using acetonitrile ensured the complete removal of salivary proteins and resulted in extraction recovery of ≥95% for all samples. The HPLC assay following extraction was linear (R2>0.99) over the range 0.3–50 µg/mL (lower limit of quantification 0.3 µg/mL). The accuracy of the quality control samples was 94–100% and the relative standard deviation (RSD) was <7% for all samples. Caffeine-spiked saliva samples were stable for three freeze-and-thaw cycles pre-extraction and up to 72 hr post-extraction. The extraction and HPLC methods described were thus suitable for the analysis of clinical trial samples from the Latte Dosage Trial. All caffeine solutions were physically and chemically stable, with concentrations at the end of the three-month test period being within 4% of the baseline concentrations, indicating appropriateness for use as clinical trial medications. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Journal of Contemporary Pediatrics is the property of Xiangya Medical Periodical Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Chinese Journal of Contemporary Pediatrics is the property of Xiangya Medical Periodical Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

OBJECTIVE Caffeine citrate doses >5 mg/kg/day are frequently used for apnea of prematurity. The primary objective was identification of patients maintained on 5 mg/kg/day (Group 1). Secondary objectives included identification of patients requiring dose increases: 7.5 mg/kg every 24 hours (Group 2), 10 mg/kg every 24 hours (Group 3), and 5 mg/kg every 12 hours (Group 4); comparison of demographics and clinical characteristics; and identification of patients requiring dose adjustments owing to caffeine-associated tachycardia. METHODS Retrospective study of neonates born between 23 to <31 weeks' gestation, receiving caffeine between January 1, 2015, and July 31, 2019. Patients receiving caffeine <1 week, initial maintenance dose >5 mg/kg/day, or with congenital abnormalities were excluded. Descriptive and inferential statistics were performed, with a p < 0.05. RESULTS Overall, 281 patients were included, with 99 (35.2%) in Group 1; 56 (19.9%) in Group 2; 47 (16.7%) in Group 3; and 79 (28.1%) in Group 4. Significant differences in gestational age were noted, with Group 3 and 4 patients being more premature than Groups 1 and 2 (p < 0.001). Dose increases occurred at a median postnatal age and postmenstrual age of 13.0 days and 31.4 weeks in Group 2; 17.0 days and 30.3 weeks in Group 3; and 16.0 days and 30.1 weeks in Group 4. Significant differences were noted for development of tachycardia requiring dose adjustment, with Groups 3 and 4 having the highest percentage (p < 0.001). CONCLUSIONS Two-thirds received caffeine citrate doses >5 mg/kg/day, with 44% receiving 10 mg/kg/day. Further exploration is necessary to determine the optimal PNA or PMA for dose adjustments. [ABSTRACT FROM AUTHOR]