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Gastrointestinal effects of caffeine in preterm infants: a systematic review and Bayesian meta-analysis
  1. Beatriz Gama1,
  2. Madalena von Hafe2,
  3. Rafael Vieira3,4,
  4. Henrique Soares1,5,
  5. Inês Azevedo1,2,
  6. Gustavo Rocha5
  1. 1 Department of Gynecology-Obstetrics and Pediatrics, Universidade do Porto Faculdade de Medicina, Porto, Portugal
  2. 2 Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
  3. 3 Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Universidade do Porto Faculdade de Medicina, Porto, Portugal
  4. 4 Center for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Universidade do Porto Faculdade de Medicina, Porto, Portugal
  5. 5 Department of Neonatology, Centro Hospitalar Universitario de Sao Joao, Porto, Portugal
  1. Correspondence to Dr Gustavo Rocha; gusrocha{at}sapo.pt

Abstract

Objective Caffeine is widely used in preterm infants to prevent or treat apnoea of prematurity. Adverse gastrointestinal effects of caffeine have not been thoroughly researched in preterm infants. With this systematic review and meta-analysis, we aim to summarise the results of trials on the gastrointestinal effects of caffeine in preterm infants.

Design We searched MEDLINE, Web of Science, Scopus and ClinicalTrials.gov up to 21 April 2023. We included randomised controlled trials assessing caffeine versus placebo in preterm neonates and reporting gastrointestinal side effects. Risk of bias was assessed using the Cochrane Risk of Bias tool. A Bayesian meta-analysis was performed to estimate the pooled OR of gastrointestinal side effects.

Results Nine trials involving 2746 preterm infants were analysed. Seven trials assessing necrotising enterocolitis and four trials assessing feeding intolerance in our meta-analysis found no differences between caffeine and placebo (OR=1.007 (95% credible interval 0.021, 5.462), I2=97.4%, and OR=1.266 (95% credible interval 0.064, 28.326), I2=84.8%, respectively). Four trials assessed the outcomes spontaneous intestinal perforation, constipation, gastrointestinal disorder (composite outcome: gastro-oesophageal regurgitation or dilated bowel loops), age at oral feeding and cholestasis syndrome and found no differences between groups. One trial assessed the outcomes gastro-oesophageal symptoms and duration of tube feeding and found that caffeine was associated with a reduced burden of gastro-oesophageal reflux symptoms at 2 weeks (p<0.05), but not at term.

Conclusions According to this systematic review and meta-analysis, the use of caffeine at usual doses in preterm infants does not seem to be associated with significant gastrointestinal adverse effects.

  • intensive care units, neonatal
  • neonatology
  • therapeutics
  • pharmacology

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Contributors GR presented the idea and RV contributed to the conception and design of the article. RV created the search queries and searched all four databases. BG and MvH reviewed all articles retrieved by the search and collected data. RV oriented the group regarding the methodological aspects of the study and performed both meta-analyses. HS, IA, RV and GR critically revised the work. All authors contributed equally to the manuscript. GR is guarantor.

  • 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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.