Optimizing Caffeine Use and Risk of Bronchopulmonary Dysplasia in Preterm Infants: A Systematic Review, Meta-analysis, and Application of Grading of Recommendations Assessment, Development, and Evaluation Methodology

Clin Perinatol. 2018 Jun;45(2):273-291. doi: 10.1016/j.clp.2018.01.012. Epub 2018 Mar 7.

Abstract

Caffeine reduces the risk of bronchopulmonary dysplasia (BPD). Optimizing caffeine use could increase therapeutic benefit. We performed a systematic-review and random-effects meta-analysis of studies comparing different timing of initiation and dose of caffeine on the risk of BPD. Earlier initiation, compared to later, was associated with a decreased risk of BPD (5 observational studies; n = 63,049, adjusted OR 0.69; 95% CI 0.64-0.75, GRADE: low quality). High-dose caffeine, compared to standard-dose, was associated with a decreased risk of BPD (3 randomized trials, n = 432, OR 0.65; 95% CI 0.43-0.97; GRADE: low quality). Higher quality evidence is needed to guide optimal caffeine use.

Keywords: Caffeine; Dose; Duration; Infant; Methylxanthine; Neonate; Preterm; Timing.

Publication types

  • Meta-Analysis
  • Research Support, N.I.H., Extramural
  • Systematic Review

MeSH terms

  • Adult
  • Bronchopulmonary Dysplasia / drug therapy*
  • Bronchopulmonary Dysplasia / prevention & control
  • Caffeine / therapeutic use*
  • Confidence Intervals
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Female
  • Gestational Age
  • Humans
  • Infant, Newborn
  • Infant, Premature*
  • Male
  • Observational Studies as Topic
  • Odds Ratio
  • Practice Guidelines as Topic*
  • Pregnancy
  • Randomized Controlled Trials as Topic
  • Reference Values
  • Time Factors
  • Treatment Outcome

Substances

  • Caffeine