Caffeine
Conditions
Keywords
caffeine, intubation, hemodynamic
Brief summary
Premature infants are at risk of having pauses in breathing, or apneas, due to their immaturity. Premature infants are routinely given caffeine, a respiratory stimulant, on the first day of life to prevent apneas. However, if they continue to have apneas, they may require a breathing tube to be placed in the trachea. There are risks to having a breathing tube, so it would be beneficial to avoid it if possible. If caffeine is given earlier, it may decrease the need for a breathing tube. Some studies also suggest that caffeine may also improve heart function which may prevent low blood pressure if given early.
Detailed description
This goal of this observational study is to compare the respiratory and acute hemodynamic effects of caffeine administered in the first 2 hours versus 12 hours of life in infants \<29 weeks gestation. Our primary hypothesis is that caffeine administered in the first two hours of life can prevent the need for endotracheal intubation in the first 12 hours of life.. These evaluations are critical in determining both the safety and efficacy of early caffeine therapy.
Interventions
DRUGCaffeine
Infants will receive a blinded dose of either placebo (IV normal saline) or IV caffeine citrate 20mg/kg infused over 10 minutes within the first 2 hours of life. They will receive a blinded dose of the opposite of what they received in the DR (placebo or caffeine) at 6 hours of life. Therefore, the intervention is timing of initial caffeine dose.
Sponsors
Sharp HealthCare
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
TRIPLE (Subject, Caregiver, Investigator)
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* Any infant delivered at Sharp Mary Birch Hospital between 23 and 28 6/7 weeks; gestation
Exclusion criteria
* Any infant with a major congenital anomaly including airway anomalies, congenital diaphragmatic hernia, or hydrops * Any infant with a known or a discovered major cardiac defect other than a patent ductus arterious (PDA), patent foramen ovale (PFO), or small ventricular septal defect (VSD) * Inability to place a peripheral IV after two attempts. Severe apnea or bradycardia in the first 60 minutes of life requiring emergent endotracheal intubation.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Intubation | First 12 hours of life | The primary aim of our study is to compare the respiratory effects of caffeine administered in the first 2 hours versus at 12 hours of life in infants \<29 weeks' gestation. Our primary hypothesis is that early caffeine administered (at \< 2 hours of life) can prevent the need for endotracheal intubation in the first 12 hours of life. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Subjects Requiring Inotropes in the First 24 Hours | first 24 hours of life | To determine if a loading dose of intravenous caffeine administered to preterm infants (\< 29 weeks) within the first 2 hours of life compared to 12 hours of life decreases the need for inotropes for hypotension within the first 24 hours of life. |
| Systemic Blood Flow | first 24 hours | To determine if a loading dose of intravenous caffeine administered to preterm infants (\< 29 weeks) within the first 2 hours of life compared to 12 hours of life results in improved measures of systemic blood flow (measured by superior vena cava flow) |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Early Caffeine Infants will receive a blinded dose of either placebo (IV normal saline) or IV caffeine citrate 20mg/kg infused over 15 minutes within the first 2 hours of life. If the infant is in the early caffeine group, the blinded drug will be IV caffeine citrate 20mg/kg in the first 2 hours and placebo at 12 hours of life.
Caffeine: Infants will receive a blinded dose of either placebo (IV normal saline) or IV caffeine citrate 20mg/kg infused over 10 minutes within the first 30 minutes of life. They will receive a blinded dose of the opposite of what they received in the DR (placebo or caffeine) at 6 hours of life. Therefore, the intervention is timing of initial caffeine dose. | 11 |
| Routine Caffeine Infants will receive a blinded dose of either placebo (IV normal saline) or IV caffeine citrate 20mg/kg infused over 10 minutes within the first 2 hours of life. If the infant is in the routine caffeine group, the blinded drug will be placebo in the DR and IV caffeine citrate 20mg/kg at 12 hours of life.
Caffeine: Infants will receive a blinded dose of either placebo (IV normal saline) or IV caffeine citrate 20mg/kg infused over 10 minutes within the first 30 minutes of life. They will receive a blinded dose of the opposite of what they received in the DR (placebo or caffeine) at 6 hours of life. Therefore, the intervention is timing of initial caffeine dose. | 10 |
| Total | 21 |
Baseline characteristics
| Characteristic | Total | Early Caffeine | Routine Caffeine |
|---|---|---|---|
| Age, Categorical <=18 years | 21 Participants | 11 Participants | 10 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 0 Participants | 0 Participants | 0 Participants |
| Region of Enrollment United States | 21 participants | 11 participants | 10 participants |
| Sex: Female, Male Female | 11 Participants | 6 Participants | 5 Participants |
| Sex: Female, Male Male | 10 Participants | 5 Participants | 5 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 11 | 0 / 10 |
| serious Total, serious adverse events | 0 / 11 | 0 / 10 |
Outcome results
Primary
Intubation
The primary aim of our study is to compare the respiratory effects of caffeine administered in the first 2 hours versus at 12 hours of life in infants \<29 weeks' gestation. Our primary hypothesis is that early caffeine administered (at \< 2 hours of life) can prevent the need for endotracheal intubation in the first 12 hours of life.
Time frame: First 12 hours of life
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Early Caffeine | Intubation | 3 participants |
| Routine Caffeine | Intubation | 7 participants |
Secondary
Subjects Requiring Inotropes in the First 24 Hours
To determine if a loading dose of intravenous caffeine administered to preterm infants (\< 29 weeks) within the first 2 hours of life compared to 12 hours of life decreases the need for inotropes for hypotension within the first 24 hours of life.
Time frame: first 24 hours of life
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Early Caffeine | Subjects Requiring Inotropes in the First 24 Hours | 0 Participants |
| Routine Caffeine | Subjects Requiring Inotropes in the First 24 Hours | 2 Participants |
Secondary
Systemic Blood Flow
To determine if a loading dose of intravenous caffeine administered to preterm infants (\< 29 weeks) within the first 2 hours of life compared to 12 hours of life results in improved measures of systemic blood flow (measured by superior vena cava flow)
Time frame: first 24 hours
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Early Caffeine | Systemic Blood Flow | SVC flow | 101 ml/kg/min | Standard Deviation 25 |
| Early Caffeine | Systemic Blood Flow | RVO | 273 ml/kg/min | Standard Deviation 62 |
| Routine Caffeine | Systemic Blood Flow | SVC flow | 77 ml/kg/min | Standard Deviation 24 |
| Routine Caffeine | Systemic Blood Flow | RVO | 219 ml/kg/min | Standard Deviation 43 |