Original ArticleTrends in Caffeine Use and Association between Clinical Outcomes and Timing of Therapy in Very Low Birth Weight Infants
Section snippets
Methods
We used a large, multicenter dataset from the Pediatrix Medical Group.16 The use of this dataset has been described previously.1 Infants discharged between 1997 and 2010 were eligible for evaluation of primary and secondary outcomes if they met the following inclusion criteria: (1) receipt of caffeine during the course of hospitalization; (2) VLBW (<1500 g birth weight); and (3) admission within 1 day of birth. Exclusion criteria included treatment with multiple methylxanthines and early
Results
Of the 54 707 infants meeting the study's inclusion criteria, 29 070 (53%) were PS-matched at 1:1 (Figure 1). PS-matched infants in the early and late caffeine groups had similar baseline characteristics, with no significant differences in any of the matched variables, including mean birth weight (1055 g vs 1054 g; P = .77) and GA (28.1 weeks vs 28.0 weeks; P = .70) (Table I).
Discussion
In VLBW infants, early caffeine initiation was associated with reduced neonatal morbidity, including a decreased incidence of BPD and of PDA requiring treatment. In addition, the centers in this study have shifted toward earlier initiation of caffeine therapy over time, with a majority of VLBW infants receiving early caffeine therapy in 2010. Although the observational study design limits our ability to draw inferences regarding causality, the effect of early caffeine therapy on improving
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Supported by the National Center for Advancing Translational Sciences of the National Institutes of Health (UL1TR000454 and KL2TR000455 to R.P.) and the Eunice Kennedy Shriver National Institutes of Child Health and Human Development (HHSN267200700051C, HHSN275201000003I, and 1K23HL092225-01), the American Recovery and Reinvestment Act (1R18AE000028-01 to P.S.), and the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH; UL1TR001117). The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Army, Department of Defense, US government, or NIH. The authors declare no conflicts of interest.
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Contributed equally.