262 - Effects of Higher Caffeine Dosing on Rates of Bronchopulmonary Dysplasia and Neurodevelopmental Outcomes

Publication Number: 262.4690

Hannah Street, Hassenfeld Children's Hospital at NYU Langone, Brooklyn, NY, United States; Sadaf H. Kazmi, Hassenfeld Children's Hospital at NYU Langone, New York, NY, United States; Natalia Mavrogiannis, Hassenfeld Children's Hospital at NYU Langone, New York, NY, United States; Hrithika Ravuri, Rutgers New Jersey Medical School, Ringwood, NJ, United States; Tamera Moinuddin, Hassenfeld Children's Hospital at NYU Langone, New York City, NY, United States; Kristyn Pierce, New York University Grossman School of Medicine, New York, NY, United States; Sourabh Verma, Hassenfeld Children's Hospital at NYU Langone, New York City, NY, United States; Sarah Fleishaker, Hassenfeld Children's Hospital at NYU Langone, New York, NY, United States

Background: Bronchopulmonary Dysplasia (BPD) is the most common complication associated with prematurity. Caffeine citrate is a commonly used medication in the neonatal intensive care unit (NICU) for apnea of prematurity (AOP). In the Caffeine Therapy for Apnea of Prematurity study, or CAP trial, it was seen that infants that received caffeine at 5mg/kg had reduced rates of BPD compared to the placebo group. Recently, there have been questions regarding the optimal dose of caffeine and if higher doses may have increased benefit on decreasing rates of BPD.

Objective: The objectives of this study were to determine if infants who received a higher maintenance dose of caffeine have decreased rates of BPD, decreased severity of BPD and improved neurodevelopmental outcomes compared to those who received a lower maintenance dose of caffeine.

Design/Methods: This was an IRB exempt retrospective, observational cohort study at a level IV NICU including infants less than 28 weeks gestational age (GA) receiving caffeine. Maternal and infant demographics and clinical data from the infant's hospital course were collected. Infants were assigned to low dose (n=62) or high dose (n=111) cohorts based on average daily caffeine dose. The low dose cohort received an average daily dose of ≤6mg/kg/day while the high dose cohort received an average daily dose of >6mg/kg/day.

Results: Demographics and clinical characteristics were similar between the low and high dose caffeine groups. The duration of caffeine in each group was similar as well. The percentage of individuals requiring invasive ventilation were similar between the two groups, however, infants in the high dose group required less intense forms of ventilation and were on invasive ventilation for a shorter time than the low dose group (Table 1). The rates of BPD were similar in the two groups (79% vs 78%, p=0.92), however the severity of BPD based on Jensen Criteria was significantly different between the two groups (p < 0.001) (Table 2 and 3). Patients in the higher dose caffeine group had higher Bayley composite scores at 6 months (p < 0.02) (Table 3).

Conclusion(s): When comparing high dose to low dose caffeine, there was no significant difference in overall rates of BPD. However, those receiving higher doses of maintenance caffeine were less likely to develop severe BPD than those receiving lower doses of maintenance caffeine. There was a statistically significant difference in Bayley composite scores at 6 months, with the high dose cohort having a higher composite score. No significant differences in development were noted at later follow-up.

Table 1. Requirement for Ventilation


Table 2. Development of BPD


Table 3. Regression analysis for Development of Severe BPD and Bayley Cognitive Scores at 6 months. ٭Logistic regression ✝Linear regression