Evaluation of Once-Daily vs. Twice-Daily Dosing of Caffeine for Apnea of Prematurity Aubrey Rebentisch, Karen Kovey Mission Hospitals - Asheville, NC
Background/Purpose: Caffeine works to ameliorate apnea in premature infants through stimulation of respiratory neural output and is considered a relatively safe medication with a wide therapeutic index, long half-life, and few associated adverse effects. Standard dosing of caffeine citrate for apnea of prematurity is a 20 mg/kg loading dose given intravenously or enterally, followed by a 5-10 mg/kg once-daily maintenance dose. While no studies have evaluated a twice-daily dosing schedule of caffeine for apnea of prematurity, physicians at Mission Hospital often administer the maintenance dose of caffeine in two divided doses. Evaluation of caffeine citrate dosed twice daily is needed in order to guide best practice in the treatment of apnea of prematurity at Mission Hospital.
Methodology: This is an Institutional Review Board approved, retrospective chart review of infants delivered at < 32 weeks gestation with documented administration of caffeine dosed once daily and twice daily. Exclusion criteria include infants with congenital diaphragmatic hernia, hydrops, genetic abnormalities, or documentation of invasive mechanical ventilation during the study period. The primary objective is to assess the incidence of apnea and bradycardia in infants before and after switching from a once-daily to a twice-daily dosing schedule of caffeine. Secondary objectives include incidence of tachycardia, GERD, NEC, tachypnea, bradycardia, BPD, severe desaturation events, hospital length of stay, growth failure weight on day of life 7/14/21/90, time to reach full enteral feeds, sepsis, anemia, and days on oxygen/positive airway pressure.
Presentation Objective: Describe the outcome of a twice-daily dosing regimen of caffeine for apnea of prematurity.
Self-Assessment: True or False: The maintenance dose of caffeine used for apnea of prematurity is currently labeled for twice-daily administration.
