WIP 37 - Continuation of Caffeine Beyond 34-weeks Postmenstrual Age

Poster Number: WIP 37
Publication Number: WIP 37.2551

Background: Caffeine reduces the incidence of both apnea and bronchopulmonary dysplasia, and it may improve neurodevelopmental outcomes by decreasing the frequency of intermittent hypoxic episodes (IHE). Our clinical practice had been to start caffeine therapy for extremely preterm infants shortly after birth and discontinue it when apnea of prematurity resolved or at 34 wks postmenstrual age (PMA), whichever was first. However, recent evidence suggests that continuation of caffeine beyond 34 wks PMA may decrease the frequency of IHE and facilitate weaning from respiratory support. In June 2023, we implemented a NICU guideline to continue caffeine therapy until 37 wks PMA for infants born at ≤ 29 wks and still having IHE or requiring respiratory support or cannula.

Objective: To compare the incidence of IHE (apnea, bradycardia, and/or oxygen desaturation), length of stay, and duration of respiratory support or nasal cannula for preterm infants requiring respiratory support or oxygen at 34 wks PMA who discontinued caffeine at ≤ 34 wks vs ≤ 37 wks PMA.

Design/Methods: This is an IRB-approved retrospective study, exempt from informed consent. Data are collected from the EMR for infants born at ≤ 29 wks and requiring respiratory support or nasal cannula at 34 wks PMA. For the “early” group (Dec 2022-Apr 2023), caffeine was discontinued at ≤ 34 wks PMA. For the “late” group (Jun 2023-present), caffeine was continued until the end of respiratory support or 37 wks PMA. We will compare the number of IHE for 5 days after caffeine discontinuation, PMA at discharge, respiratory support at 37 wks PMA, and the PMA at which respiratory support was discontinued between the two groups. Statistical differences will be quantified using parametric and non-parametric tests as indicated. Preliminary comparisons between the “early” (n=23) and “late” (n=8) groups reveal trends toward lower median IHE on day 5 after discontinuation of caffeine (1.5 to 1.0) and lower median PMA at discharge (39.1 to 35.8 wks) in the “late” group.