Research Shows Reduced Mortality in ELBW Infants Given Caffeine Within 48 Hours

   The administration of caffeine to extremely low birth weight (ELBW) newborns within 48 hours of life has been shown to reduce the incidence of mortality and various morbidities, according to research presented at the American Academy of Pediatrics National Conference and Exhibition in Boston.

   Zeeshan Khan, MD, and colleagues at the Division of Neonatal-Perinatal Medicine, Children's Hospital of Michigan in Detroit, performed a chart analysis of 287 ELBW (birth weight <1000 grams) newborns to note caffeine treatment, patent ductus arteriosus (PDA) treatment, incidence of intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), and mortality. The data were organized into four groups according to the start of caffeine therapy (no caffeine, </=2 days, 3-7 days, and >7 days).

   According to the investigators, the groups were comparable in terms of gender ratio (P=0.056) and race (P=0.8), but significantly different by gestational ages using one way ANOVA (P=0.005). On Scheffe’s post hoc analysis, there was no statistically significant difference in gestational age between the caffeine at </=2 days and no caffeine (P=0.148) groups. However, the gestational ages of newborns in the caffeine groups at 3 to 7 days (P=0.033) and >7 days (P=0.025) were significantly higher than those in no-caffeine group. Also, newborns in the no-caffeine group had significantly lower birth weights by one way ANOVA (P<0.0001).

   Dr. Khan and his associates found that the percentage of patients who received surgical treatment for PDA was lowest in the caffeine at </=2 days group (P=0.028). There was no statistically significant difference in the four groups for incidence of moderate to severe IVH (P=0.52). But BPD was found in 70% of newborns in the caffeine at >7 days group, as compared with 57% in the caffeine at </=2 days group. According to the researchers. an incidence of BPD in only 24% in the no-caffeine group may be due to a 50% mortality at <36 weeks (corrected gestational age) among them.

   Mortality was significantly higher in patients who received no caffeine (61%) as compared to those in caffeine at </=2 days group (12%) (P<0.0001). The investigators suggested a randomized prospective study to confirm the benefits of the early commencement of caffeine.