Correlation Between Serum Caffeine Levels And Outcomes in Preterm Infants.

http://www.nature.com/jp/journal/vaop/ncurrent/full/jp2014226a.html

Serum caffeine concentrations and short-term outcomes in premature infants of 29 weeks of gestation

P Alur, V Bollampalli, T Bell, N Hussain and J Liss
Abstract

Objective:


Caffeine is effective in the treatment of apnea of prematurity but it is not well known if the therapeutic concentration of the drug has an impact on other neonatal outcomes such as chronic lung disease (CLD). The aim of this study was to determine if there is an association between caffeine concentrations and the incidence of CLD in premature infants of 29 weeks of gestation.
Study design:
A retrospective chart review of all the infants born 29 weeks of gestation from 2007 to 2011, who survived until discharge or 36 weeks postmenstrual age, was conducted. Caffeine concentrations were obtained weekly on infants getting the drug. Average caffeine concentrations (ACCs) were determined for the duration of caffeine therapy and correlated with CLD, length of stay (LOS), oxygen at discharge (OD), duration of ventilation (DV) and total charges for hospitalization for each patient.


Results:

Of the 222 eligible infants, 198 met the inclusion criteria. ACC for infants without CLD was 17.0±3.8 μg ml−1 compared with infants with CLD 14.3±6.1 μg ml−1 (P<0.001). Infants receiving high ACC (>14.5 μg ml−1) had lower incidence of patent ductus arteriosus, lesser number of days on ventilator and oxygen, lesser need for diuretics, lower incidence of CLD, were more likely to go home without supplemental OD and had lower LOS and lower total hospital charges (all differences were significant P<0.05) Multiple logistic regression modeling after adjusting for confounding variables indicated that higher caffeine concentrations were significantly associated with decrease in CLD. Receiver operating curve analysis confirmed a significant predictive ability of caffeine concentration for CLD with a cutoff concentration of 14.5 μg ml−1 (sensitivity of 42.6 and specificity of 86.8). The AUC (area under the curve) for the prediction of CLD was 0.632 (95% confidence interval 0.56–0.69, P=0.009). Conclusions:

Caffeine concentrations >14.5 μg ml−1 were strongly correlated with reduced CLD in infants born at 29 weeks of gestation. Higher caffeine concentrations were associated with decreased total hospital charges, DV, OD and LOS. Additional randomized trials are needed to confirm these findings, to identify ideal serum concentrations and determine possible long-term neurologic benefits.

Umbilical Cord Milking-Evidence in Preterm Infants

http://archpedi.jamanetwork.com/article.aspx?articleID=1919654#Abstract


JAMA Pediatr. 2014 Nov 3. doi: 10.1001/jamapediatrics.2014.1906. [Epub ahead of print]
Efficacy and Safety of Umbilical Cord Milking at Birth: A Systematic Review and Meta-analysis.
Al-Wassia H1, Shah PS2.


Author information

1Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia.
2Department of Pediatrics, Mt Sinai Hospital, Toronto, Ontario, Canada3Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.



Abstract



Importance:


Umbilical cord milking (UCM) is suggested to improve neonatal outcomes.
Objectives:


To perform a systematic review and meta-analysis of the efficacy and safety of UCM in full-term and preterm neonates.
Data Sources:


A systematic search of MEDLINE, EMBASE, CINAHL, the Cochrane Database of Clinical Trials, the clinicaltrails.gov database, and the reference list of retrieved articles from 1940 to 2014.
Study Selection:


Randomized clinical trials comparing UCM with other strategies of handling the umbilical cord at birth in full-term and preterm infants. Seven of the 18 initially identified studies were selected.
Data Extraction and Synthesis:


Two reviewers independently extracted data and assessed the risk for bias in included trials using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions.
Main Outcomes and Measures:


Neonatal mortality before discharge from the hospital.
Results:


We included 7 randomized clinical trials involving 501 infants. Infants with a gestational age of less than 33 weeks allocated to UCM compared with control conditions showed no difference in the risk for mortality (risk ratio [RR], 0.75 [95% CI, 0.35 to 1.64]; risk difference [RD], -0.02 [95% CI, -0.09 to 0.04]), hypotension requiring volume expanders (RR, 0.71 [95% CI, 0.41 to 1.25]; RD, -0.09 [95% CI, -0.22 to 0.05]), or inotrope support (RR, 0.77 [95% CI, 0.51 to 1.17]; RD, -0.10 [95% CI, -0.25 to 0.05]). Higher initial levels of hemoglobin (mean difference, 2.0 [95% CI, 1.3-2.7] g/dL) and hematocrit (mean difference, 4.5% [95% CI, 1.5%-7.4%]) were identified in the UCM groups.
We found a reduced risk for oxygen requirement at 36 weeks (RR, 0.42 [95% CI, 0.21 to 0.83]; RD, -0.14 [95% CI, -0.25 to -0.04]) and for intraventricular hemorrhage of all grades (RR, 0.62 [95% CI, 0.41 to 0.93]; RD, -0.12 [95% CI, -0.22 to -0.02]) in infants assigned to UCM. Among infants with a gestational age of at least 33 weeks, UCM was associated with higher hemoglobin levels in the first 48 hours in 224 infants (mean difference, 1.2 [95% CI, 0.8-1.5] g/dL) and at 6 weeks of life in 170 infants (mean difference, 1.1 [95% CI, 0.7-1.5] g/dL).
Conclusions and Relevance:


Umbilical cord milking was associated with some benefits and no adverse effects in the immediate postnatal period in preterm infants gestational age, <33 nbsp="" p="" weeks.="">