Hi everyone,

I came across this interesting paper on discharging preterm infants home on caffeine.

Discharging Preterm Infants on Caffeine—Practise Variation Across Europe: Results of a Cross‐Sectional Survey - Kuntz - Acta Paediatrica 2026 https://onlinelibrary.wiley.com/doi/pdf/10.1111/apa.70502

In Canada, this was fairly common in my experience, with some infants going home on caffeine and then simply growing out of it over time. We also did not routinely use much home monitoring. Since working in the UK, however, I have not really seen this practice, so I had assumed it was uncommon across Europe as well. Interestingly, this paper suggests there is actually considerable variation between centres.

What is your practice locally? How do you feel about discharging infants home on caffeine? Do you think it is a safe approach, or are there concerns that make you hesitant?

Hi @Mo7 , recently I gave a talk on apnea focused respiratory monitoring in a conference, and was also surprised about many different approaches!

In southern Finland (where I do my research) it's not uncommon to discharge kids home on caffeine. There's a lot of trust towards parents abilities here, so it aligns well with other practices ( eg. kotiloma, I even committed a blog post about it ages ago: https://99nicu.org/blogs/entry/330-kotiloma-means-vacation-at-home/). From what I understand, they later admit caffeine-at-home kids for an overnight observation in the ped unit (SpO2 and HR, Edi monitoring if possible) when they try to wean off the medication, and only then make a final decision. Everybody is quite chill about it (but hey, it's Finland). A small proportion of the kids in my study were on caffeine at home (7/99 included) until median age of 45 weeks PMA (data still unpublished).

This is a common practice in some centres in Nigeria. Many do well and it was a good option especially for a lower resourced setting and it appeared to be cost effective. In the UK it's not a common practice. I think it helps though. Guidelines varies on when to stop. Some give till 34 weeks, others 36 and 40 weeks respectively.

Here in the UK, I have discharged babies home on caffeine and allowed them to grow out of the dose. however lately it has not been possible as no one else seems do this in UK and my colleagues weren't happy.

I work in Scotland. Our unit actively looks for ibtermittent hypoxia on saturation studies predischarge and then treats with home oxygen. Almost all of our <28/40 go home on oxygen as a result although many of them would pass an air test and not have BPD. We are looking into prolonged treatment with caffeine instead to treat IH similar to the iCaf study. We as a group are open to embracing this but undecided about how long to treat for and how to stop. What are people doing?

In our unit we do not discharge home on Caffeine. Most premature infants have Caffeine discontinued at 34 weeks. Caffeine may be restarted for a short time if apneic episodes recur, but is almost always stopped by 36 weeks.