Early caffeine citrate administration linked to reduced acute kidney injury risk in preterm neonates

Early caffeine citrate administration linked to reduced acute kidney injury risk in preterm neonates

April 2, 2018

According to a recently published study, caffeine administration in preterm neonates was associated with reduced incidence and severity of acute kidney injury.

Acute kidney injury is common among preterm neonates and is associated with increased morbidity and mortality; however, injury occurred less frequently among neonates who received caffeine administration than those who did not.

Between October 2016 and December 2017, researchers examine data from 675 neonates born between January 1 and March 31, 2014 as part of a retrospective, international multicenter cohort study called AWAKEN. The analysis revealed that 30% of neonates admitted to an intensive care unit developed acute kidney injury and had almost 5 times higher adjusted odds for mortality compared with neonates without acute kidney injury.

According to the investigators, 447 neonates received at least one dose of caffeine during the first 7 days after birth and before AKI. Regarding the 228 neonates considered to have not received caffeine, 199 received no caffeine during the first 7 days after birth, whereas 29 received caffeine only after AKI. Further, 249 of the 675 received their first dose of caffeine on day 1 after birth, and 363 of 675 received their first dose within the first 2 days after birth.

Investigators noted that, while caffeine administration in the first 7 days after birth may correlate with less frequent acute kidney injury in preterm neonates, further studies on dosage, timing of administration, and long-term outcomes are required.

"In this large multicenter, retrospective study, we found that only 4 neonates needed to be treated with caffeine to prevent one-episode acute kidney injury.  Surprising to our group, the caffeine-treated neonates were the ‘sicker’ group yet still had a lower rate of AKI. We also saw a reduction of AKI which extended to the very preterm group (including 28- to 32-week neonates), a population that does not routinely receive caffeine,” Jennifer R. Charlton, MD, MSc, University of Virginia, department of pediatrics, division of nephrology, and senior author of the study, told Healio Nephrology. “This study highlights the need for a prospective study to determine if caffeine can prevent AKI and more importantly, if caffeine could have a role in reducing the longer-term burden of chronic kidney disease in this vulnerable population." – by Jake Scott

Disclosure: The authors report no relevant financial disclosures.

Full article here.

https://www.healio.com/nephrology/acute-kidney-injury/news/online/%7B1cec6448-afa6-4781-b6b6-cc1e55d0a11f%7D/early-caffeine-citrate-administration-linked-to-reduced-acute-kidney-injury-risk-in-preterm-neonates

NEONATAL CAFFEINE USE FOR APNEA DOESN'T AFFECT LONG TERM SLEEP

Check Up: Study finds premature birth a risk factor for sleep troubles

September 8, 2014

The very idea of caffeinating fragile preemies may sound misguided. But eight years ago, an international study that compared the stimulant to a placebo found it had benefits, including relieving sleep apnea.

Still, there were lingering concerns. Caffeine works in the brain, blocking a molecule that promotes sleep. Animal studies suggest that such early biochemical tinkering can lead to permanent sleep and breathing abnormalities.

"I think we all know from daily life the effect that caffeine has on us," said lead author Carole L. Marcus, a pediatric pulmonologist and director of the sleep center at Children's Hospital. "We give the equivalent of six cups of coffee a day for a week or more - and these are little babies whose brains are still developing."

The new study, published Friday in the American Journal of Respiratory and Critical Care Medicine, tracked down 201 of the original 2006 premature babies, now ages 5 to 12. Half had gotten caffeine therapy, the other half a placebo.

For two weeks, the children wore a noninvasive sensor at night to monitor their sleep. The parents also filled out questionnaires.

There were no differences in the children's sleep patterns, including how long they took to fall asleep and how soundly they slept.

But both caffeine and placebo groups had high rates of sleep disorders. Overall, about 10 percent had periodic limb movement disorder (episodes of involuntary movement, usually of the legs), and 14 percent had obstructive sleep apnea. In general, less than 4 percent of school-age children have apnea, and 5 percent to 8 percent have the limb movement disorder.

Obstructive sleep apnea is different from the apnea of prematurity. In the obstructive form, the throat airway collapses or becomes blocked. In preemies, breathing stops because their immature nervous systems cannot yet enable continuous respiration.

Obstructive apnea can lead to daytime sleepiness, learning problems, high blood pressure, and heart disease. Limb movement disorder is less understood but has been linked to attention deficit hyperactivity disorder and a serious sleep problem called restless leg syndrome.

If caffeine isn't a culprit, why are sleep disorders common in former premature babies?

One possibility, the researchers noted, is enlarged tonsils. About a quarter of the children had already undergone tonsillectomies, the primary treatment for childhood obstructive sleep apnea.

"We're thinking the rate of apnea would have been even higher if not for the tonsillectomies," Marcus said.

The limb movement may be related, at least partly, to iron deficiency. Low blood iron levels were found in the children with the movement disorder who underwent testing.

All the children with apnea or limb movement disorder were referred for more testing and treatment, but most former preemies are not even checked for such problems. The study suggests that should change.

"We should be screening these children," Marcus said. "Then we could prevent problems, or treat them earlier."