Caffeine therapy for apnea of prematurity
Caffeine therapy for apnea of prematurity
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DOI：
10.1056/nejmoa054065
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发表时间：
2006-05-18
影响因子：
158.5
通讯作者：
Tin, W
中科院分区：
文献类型：
--
作者：
Schmidt, B;Roberts, RS;Tin, W
背景资料：甲基黄嘌呤减少早产儿呼吸暂停的频率，并在治疗的前七天内减少对机械通气的需求。目前还不确定甲基黄嘌呤是否有其他短期和长期的好处或风险，在婴儿非常低的出生体重。方法：我们随机分配2006年出生体重为500至1250克的婴儿在生命的第一个10天接受咖啡因或安慰剂，直到药物治疗早产儿呼吸暂停不再需要。我们在第一次出院回家前评估了短期结果。结果：在963名接受咖啡因治疗并在月经后36周仍存活的婴儿中，有350名婴儿954名婴儿中有447名接受了辅助供氧，（47%）分配到安慰剂组（调整的比值比，0.63; 95%置信区间，0.52至0.76; P < 0.001）。咖啡因组婴儿（中位经后年龄，31.0周;四分位距，29.4 ~ 33.0）比安慰剂组婴儿（中位经后年龄，32.0周;四分位距，30.3 ~ 34.0; P < 0.001）提前一周停止气道正压通气。咖啡因暂时减少了体重增加。两周后，咖啡因组和安慰剂组之间体重增加的平均差异最大（平均差异，-23 g; 95%置信区间，-32至-13; P < 0.001）。死亡率，脑损伤，坏死性小肠结肠炎的超声征象并没有显着差异两组之间。结论：咖啡因治疗早产儿呼吸暂停降低极低出生体重儿支气管肺发育不良的发生率。（ClinicalTrials.gov编号，NCT 00182312.）。
Background: Methylxanthines reduce the frequency of apnea of prematurity and the need for mechanical ventilation during the first seven days of therapy. It is uncertain whether methylxanthines have other short- and long-term benefits or risks in infants with very low birth weight.Methods: We randomly assigned 2006 infants with birth weights of 500 to 1250 g during the first 10 days of life to receive either caffeine or placebo, until drug therapy for apnea of prematurity was no longer needed. We evaluated the short-term outcomes before the first discharge home.Results: Of 963 infants who were assigned to caffeine and who remained alive at a postmenstrual age of 36 weeks, 350 (36 percent) received supplemental oxygen, as did 447 of the 954 infants (47 percent) assigned to placebo (adjusted odds ratio, 0.63; 95 percent confidence interval, 0.52 to 0.76; P < 0.001). Positive airway pressure was discontinued one week earlier in the infants assigned to caffeine (median postmenstrual age, 31.0 weeks; interquartile range, 29.4 to 33.0) than in the infants in the placebo group (median postmenstrual age, 32.0 weeks; interquartile range, 30.3 to 34.0; P < 0.001). Caffeine reduced weight gain temporarily. The mean difference in weight gain between the group receiving caffeine and the group receiving placebo was greatest after two weeks (mean difference, -23 g; 95 percent confidence interval, -32 to -13; P < 0.001). The rates of death, ultrasonographic signs of brain injury, and necrotizing enterocolitis did not differ significantly between the two groups.Conclusions: Caffeine therapy for apnea of prematurity reduces the rate of bronchopulmonary dysplasia in infants with very low birth weight. (ClinicalTrials.gov number, NCT00182312.).