Caffeine citrate for very preterm infants: Effects on development, temperament and behaviour

Aim:  To compare two dosing regimens for caffeine citrate for neonates born less than 30 weeks gestation in terms of development, temperament and behaviour. Methods:  A multi‐centre, randomised, controlled trial design was undertaken. A total of 287 infants with apnoea of prematurity or in the peri‐...

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Bibliographic Details
Published in:Journal of paediatrics and child health 2011-04, Vol.47 (4), p.167-172
Main Authors: Gray, Peter H, Flenady, Vicki J, Charles, Bruce G, Steer, Peter A
Format: Article
Language:English
Subjects:
Age
Australia - epidemiology
behaviour
Caffeine
Caffeine - administration & dosage
Caffeine - pharmacology
Central Nervous System Stimulants - administration & dosage
Central Nervous System Stimulants - pharmacology
Child Development - drug effects
Citrates - administration & dosage
Citrates - pharmacology
Clinical outcomes
clinical trials
cognitive ability
development
disabilities
Dose-Response Relationship, Drug
Female
Gestational Age
Humans
Infant
Infant Behavior - drug effects
Infant Mortality - trends
Infant, Newborn
Infants
Male
Morbidity
Mortality
Neonatal care
Neonates
Pediatrics
Premature Birth
preterm
Surveys and Questionnaires
temperament
Temperament - drug effects
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Summary:Aim:  To compare two dosing regimens for caffeine citrate for neonates born less than 30 weeks gestation in terms of development, temperament and behaviour. Methods:  A multi‐centre, randomised, controlled trial design was undertaken. A total of 287 infants with apnoea of prematurity or in the peri‐extubation period were randomised to receive one of two dosage regimens (20 vs. 5 mg/kg/day). The main outcome measure was cognitive development at 1 year of age on the Griffiths Mental Development Scales. Secondary outcome measures included neonatal morbidity, death and disability, temperament at 1 year and behaviour at 2 years of age. Results:  Data on the primary outcome were available for 190 survivors at 12 months corrected for prematurity. A significantly greater mean general quotient was found in the high‐dose group (mean (standard deviation), 98.0 (13.8) vs. 93.6 (16.5), P= 0.048). On omission of two infants for whom cognitive assessment was not possible because of disability while the mean general quotient remained higher for infants in the high‐dose group, this was no longer statistically significant (P= 0.075). There was a non‐significant trend for benefit in the high‐dose caffeine group for death or major disability, 15.4% versus 24.2%; relative risk 0.75 (95% confidence interval 0.49–1.14). No differences in the mean values between the two groups were shown for temperament and behaviour. Conclusions:  Caffeine citrate with a dosage regimen of 20 mg/kg/day did not result in adverse outcomes for development, temperament and behaviour. The borderline benefit in cognition with high‐dose caffeine needs further investigation.
ISSN:1034-4810
1440-1754
DOI:10.1111/j.1440-1754.2010.01943.x