What's the criteria to start prophylactic caffeine citrate

Caffeine may be able to prevent postoperative apnoea and bradycardia in preterm babies and prophylactic caffeine in extremely low birth weight infants (birth weight <1000 g) may be used to avoid intubation and mechanical ventilation. However, data are limited on the effect of prophylactic methylxanthines use in premature infants on the incidence of apnea and related symptoms. 

 

 

Reference : 

 

Henderson-Smart DJ, Steer PA. Prophylactic caffeine to prevent postoperative apnea in preterm infants. Cochrane Database of Systematic Reviews 2004, Issue 4. Art. No.: CD000048. DOI: 10.1002/14651858.CD000048.

 

Henderson-Smart DJ, De Paoli AG. Prophylactic methylxanthine for prevention of apnoea in preterm infants. Cochrane Database Syst Rev 2010; :CD000432.

 

Patel RM, Leong T, Carlton DP, Vyas-Read S. Early caffeine therapy and clinical outcomes in extremely preterm infants. J Perinatol 2013; 33:134.

What about pre-extubation caffeine, dose ( induction only or complete with maintainance, and for how long ) can I use it in pre extubation in FT baby with difficult of weaning from mech ventilator or not

Its a pretty tough question to answer. as good level of evidence is not available for guidance. 

 

Caffeine use is mainly for central apnea , which is seen in  pretrems (usually  < 32 weeks)  bacause of immature respiratory centre and it acts by stimulation of respiratory neural output possibly  by inhibiting adenosine receptors and also by increased ventilatory responsiveness to carbon dioxide, reversal of central hypoxic depression of breathing, increasing force of diaphragmatic contraction and improved pharyngeal muscle tone.

 

 I have not personally used Caffeine in Term babies or being seen used in any unit. Caffeine may have some role in Obstructive Sleep apneoa in bigger or mature babies. Difficulties of weaning in term babies may be because of other reasons (eg Myasthenia, myo or neuropathies) than central apnea which should be investigated further. 

 

For use of  caffeine in preterm for apnea you can use following  cocrane reviews for gudance. 

 

Henderson-Smart DJ, Steer PA. Prophylactic caffeine to prevent postoperative apnea in preterm infants. Cochrane Database of Systematic Reviews 2004, Issue 4. Art. No.: CD000048. DOI: 10.1002/14651858.CD000048.

 

Henderson-Smart DJ, De Paoli AG. Prophylactic methylxanthine for prevention of apnoea in preterm infants. Cochrane Database Syst Rev 2010; :CD000432

 

 

you can see attached paper for guidance for post extubation caffeine by PA Steer(Australia)

 

Regards

 

H Sharma

cafeinaextubacion.pdf