436 - Caffeine Prophylaxis within 4 Hours of Birth and Risk of Non-Invasive Respiratory Support Failure

Poster Number: 436
Publication Number: 436.227

Anand Salem, Emory University School of Medicine, Decatur, GA, United States; Rebecca Dryer, Johns Hopkins Children's Center, Baltimore, MD, United States; Vivek Saroha, Emory Children's Pediatric Institute, Atlanta, GA, United States; Ravi M. Patel, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, United States

Background: Non-invasive support is increasing in use as initial respiratory support in very low birth weight infants. However, many infants fail non-invasive support and need subsequent mechanical ventilation or surfactant. Caffeine may improve respiratory dynamics including increases in minute ventilation, average inspired tidal volumes, and diaphragmatic contractility within minutes to hours of administration. It is unknown if very early caffeine initiation within hours of birth reduces the risk of non-invasive respiratory support failure.

Objective: To determine if caffeine initiated within 4 hours of birth, compared to later initiation, is associated with a lower risk of non-invasive respiratory support failure, defined by subsequent need for endotracheal ventilation within 72 hours of age.

Design/Methods: We conducted a retrospective, observational cohort study examining very low birth weight ( < 1500 g) infants born at a level III neonatal intensive care unit from 8/1/08-7/31/17.  We included infants on any non-invasive positive airway pressure respiratory support upon unit admission and excluded infants transferred within 72 hours of birth or with missing initial respiratory support data. The primary exposure was caffeine initiation within 4 hours of birth. This cut-point was used to identify infants with very early caffeine use. The primary outcome was survival without endotracheal mechanical ventilation within 72 hours of birth, which was evaluated using multivariable Cox models, adjusting for gestational age, birth weight < 1000 g, Apgar score at 5 min, FiO2 on admission and receipt of antenatal steroids, specified as none, partial or a complete course.

Results: We analyzed 283 infants, of which 45% (126/283) needed subsequent endotracheal mechanical ventilation within 72 hours of birth. The median (interquartile range) gestational age of the cohort was 28.9 weeks (27.3-30.1) and initial FiO2 was 0.25 (0.21-0.30). The median age of caffeine initiation was 7 hours (4-24) and 82 (29%) infants received caffeine within 4 hours of birth. Patient characteristics by outcome groups are shown in Table 1. Caffeine within 4 hours of birth was not associated with a lower rate of non-invasive support failure in the first 72 hours of age (adjusted hazard ratio 0.81; 95% CI 0.55-1.20). Survival curves are shown in Figure 1. Conclusion(s): Very early caffeine initiation within 4 hours of birth is not associated with a decreased risk of non-invasive respiratory support failure within 72 hours of birth.
Salem CV 12_23_21 - Copy.pdf
Figure 1. Non-Invasive Respiratory Support Failure Within 72 Hours of Birth by Caffeine Timing