Neonatologist Royal Women’s Hospital Parkville, Victoria, Australia
Background: The CAP trial (NEJM, 2006) evaluated caffeine citrate at a loading dose of 20 mg/kg and maintenance dose of 5-10 mg/kg/day. Although caffeine is among the most common medications given to very preterm infants, practice varies widely, and higher doses have been reported. Objective: To describe current use of caffeine across neonatal units within the Australian and New Zealand Neonatal Network (ANZNN). Design/Methods: A web-based, anonymized, 24-question survey was sent to 195 neonatologists from 31 tertiary neonatal units within the ANZNN in March 2023. The survey inquired about the individual’s use of caffeine in preterm infants, including the dosage and duration. Unit caffeine guidelines were also requested from designated contact persons. Data are reported using descriptive statistics. Results: 117 (60%) individual responses were received, representing neonatologists from 28 out of 31 (90%) centers. 46% of neonatologists routinely prescribed prophylactic caffeine for infants born < 32 weeks' gestation. An additional 39% used a criterion of < 30 weeks' gestation for prophylactic use. The caffeine citrate equivalent loading dose ranged from 10 to 80 mg/kg. The most common loading dose was 20 mg/kg (84%). A minority opted for loading doses either < 20 mg/kg (4%) or >20 mg/kg (12%). 65% ‘never’ or ‘rarely’ repeated the loading dose. The most common routine caffeine citrate equivalent maintenance dose was 10 mg/kg/day (65%). A maximum maintenance dose of 20 mg/kg/day was used by 43% of neonatologists, and 15 mg/kg/day by 38%. The postmenstrual age for routine caffeine cessation ranged between 34 and 40 weeks’, with a median (IQR) response of 34 weeks’ (34–36 weeks’). The majority of units (26/31 units) reported having a written guideline on caffeine use. Most units’ guidelines recommended a caffeine loading dose of 20 mg/kg (23/26 units) and a maintenance dose of 10 mg/kg/day (20/26 units). Only six guidelines suggested a postmenstrual age for caffeine cessation.
Conclusion(s): Although there are some consistencies in the use of caffeine by neonatologists in Australia and New Zealand, there are also substantial differences, particularly in caffeine dosage. This variability in clinical practice highlights the urgent need for a large RCT with long-term follow-up to determine optimal caffeine dosing.
