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Abstract
Objective To quantify trends in caffeine use in infants born at <32 weeks’ gestational age (GA), and to investigate the effects of early vs late caffeine on neonatal outcomes.
Study design Retrospective propensity score matched cohort study using routinely recorded data from the National Neonatal Research Database of infants born at <32 weeks’ GA admitted to neonatal units in England and Wales (2012–2020).
Results 89% (58 913/66 081) of infants received caffeine. In 70%, caffeine was started early (on the day of birth or the day after), increasing from 55% in 2012 to 83% in 2020. Caffeine was given for a median (IQR) of 28 (17–43) days starting on day 2 (1–3) and continued up to 34 (33–34) weeks postmenstrual age.
In the propensity score matched cohort of 13 045 pairs of infants, the odds of preterm brain injury (early caffeine, 2306/13 045 (17.7%) vs late caffeine, 2528/13 045 (19.4%), OR=0.89 (95% CI 0.84 to 0.95)) and bronchopulmonary dysplasia (BPD) (early caffeine, 4020/13 045 (32.8%) vs late caffeine, 4694/13 045 (37.7%), OR=0.81 (95% CI 0.76 to 0.85)) were lower in the group that received early caffeine compared with those who received it later.
Conclusions Early use of caffeine has increased in England and Wales. This is associated with reduced risks of BPD and preterm brain injury. Randomised trials are needed to find the optimal timing of caffeine use and the groups of infants who will benefit most from early administration of caffeine.
- intensive care units, neonatal
- pharmacology
- epidemiology
- respiratory medicine
- infant development
Data availability statement
Data are available on reasonable request. Data are available on request.
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Data availability statement
Data are available on reasonable request. Data are available on request.
Footnotes
Twitter @DrDonSharkey, @shaliniojha7
Contributors LS: participated in the concept and design, performed the analysis of data, participated in interpretation of data and drafted and revised the manuscript. SF: participated in the analysis and interpretation of data and revised the manuscript. TCK: participated in the analysis of data and revised the manuscript. JA: participated in the concept and design, analysis of data and revised the manuscript. DS: participated in the concept and design, interpretation of data and revised the manuscript. HB: participated in the concept and design, interpretation of data and revised the manuscript. SO: designed and conceptualised the study, participated in analysis and interpretation of data and drafted and revised the manuscript. SO is the guarantor of the publication. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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