Target Weaning Oxygen to Determine Duration of Caffeine for Apnea of Prematurity: a Multicenter, Prospective, Randomized Controlled Trial
试验速览
- 阶段
- 4 期
- 状态
- 已完成
- 发起方
- 入组人数
- 310
- 试验地点
- 41
- 主要终点
- duration of hospital stay after randomization
研究概览
简要总结
Caffeine, a typical representative of methylxanthine, is world-widely used to manage apnea of prematurity (AOP) in neonatology. However, an appropriate medication regimen of caffeine has not been well defined until now. For example, in terms of the duration of caffeine, AAP guideline for AOP (2016) and British NICE guideline for neonatal respiratory care (2019) all recommended discontinuing caffeine when the infants reached a postmenstrual age (PMA) ≥33weeks and had a stable respiratory status, commonly manifested by weaning from non-invasive ventilation and free of apneic episodes for at least five consecutive days. Interestingly, the actual clinical settings seem to be not strictly following this recommendation. A survey of the neonatologist in North America revealed that a substantial variability existed among sites in the timing of caffeine discontinuation before discharge and the respiratory support at the time of caffeine discontinuation [1]. Another survey in Saudi Arabia also had a similar finding [2]. The optimal timing of discontinuing caffeine is still a conundrum in the field of neonatology.
Ideally, the optimal timing of discontinuing caffeine should be individual-specific. Published work has indicated that AOP and intermittent hypoxemia (IH) were frequently observed beyond 36 weeks' PMA in all gestational age groups, particularly in the 24- to 27-week infants [3, 4]. In the clinical settings, intermittent hypoxic and AOP episodes is a predominant cause of oxygen supplement in premature infants and commonly prolong the hospital stay. Optimizing arterial saturation by oxygen supplement is essential to achieve a stable cardiorespiratory status because hypoxemia could induce hypoxic sensitivity of the carotid bodies in neonates, resulting in more pronounced ventilatory depression and more frequent apneic episodes. Some RCTs have shown that continuing caffeine administration beyond PMA 34 weeks could reduce the frequency of IH episodes in premature infants [4, 5]. Therefore, theoretically, a prolonged caffeine administration over the usual duration could shorten the duration of oxygen supplements in those infants at high risk of frequent late AOP or IH. Target weaning oxygen could be an opportunistic indicator of discontinuing caffeine.
In light of the above considerations, a multicenter, retrospective, partially blinded, controlled trials will be conducted to verify the hypothesis that a novel caffeine regimen that weaning oxygen as the indicator of discontinuing caffeine could improve respiratory outcomes of very premature infants.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Double (Investigator, Outcomes Assessor)
盲法说明
Randomization will be performed by someone who are not involved in this study. Outcomes assessor will review the patients' medical record masked for the type of intervention.The investigators performing the final statistic analyses will also be blinded to the treatment allocation.
入排标准
- 年龄范围
- 14 Days 至 6 Months（Child）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •premature infants with gestational age <30 weeks
- •postmenstral age ≥32weeks
- •a history of caffeine therapy
- •no current positive pressure respiratory support, and free of apnea for at least five consecutive days, but still oxygen dependent
- •parents or legal guardians sign informed consent to attend this study
排除标准
- •congenital cardiorespiratory malformation, or chromosomal abnormalities
- •Grade III/IV intraventricular hemorrhage, or probable brain injury attributable to confirmed central nervous system infection, severe periventricular leukomalacia or other entities;
- •underwent tracheostomy
- •currently on sedatives, opioids, or other medication related to depressed breath
研究组 & 干预措施
ongoing caffeine with oxygen supplement (group 1)
samples assigned to the "ongoing caffeine with oxygen supplement (group 1)" will continue caffeine administration combining with oxygen supplement until the patients are weaned from oxygen.
干预措施: Caffeine Citrate 20 MG/1 ML Intravenous Solution [CAFCIT] (Drug)
discontinuing caffeine with oxygen supplement (group 2)
samples assigned to the "discontinuing caffeine with oxygen supplement (group 2)" will discontinue caffeine immediately after randomization, while oxygen supplement is going on.
干预措施: Caffeine Citrate 20 MG/1 ML Intravenous Solution [CAFCIT] (Drug)
结局指标
主要结局
duration of hospital stay after randomization
时间窗: from date of randomization until the date of discharge, assessed up to 100 days of life
duration of hospital stay after randomization
recurrence of apnea of prematurity (RAP)
时间窗: from date of randomization until the date of discharge, assessed up to 100 days of life
Either of the following condition is defined as a RAP event: 1. heart rate \<100 beats/min; 2. weak respiratory effort requiring mask-bag ventilation; 3. A high-flow nasal cannula (HFNC) and various noninvasive and invasive ventilation are dictated by the clinical condition, where HFNC is defined as the oxygen flow is ≥2L/min; 4. Restarted caffeine therapy is considered at the discretion of the healthcare team.
duration of oxygen supplement after randomization
时间窗: from date of randomization until the date of discharge, assessed up to 100 days of life
duration of oxygen supplement after randomization
次要结局
- postmenstrual age of discharging home(from date of randomization until the date of discharge, assessed up to 100 days of life)
- onset of bronchopulmonary dysplasia(from date of randomization until the date of discharge, assessed up to 100 days of life)
- restart caffine therapy(from date of randomization until the date of discharge, assessed up to 100 days of life)
- severity of bronchopulmonary dysplasia(from date of randomization until the date of discharge, assessed up to 100 days of life)
- restart noninvasive ventilation(from date of randomization until the date of discharge, assessed up to 100 days of life)
- reintubating the patients(from date of randomization until the date of discharge, assessed up to 100 days of life)
- hospitalization cost after randomization(from date of randomization until the date of discharge, assessed up to 100 days of life)
研究者
Wang Jianhui
Attending neonatologist
Children's Hospital of Chongqing Medical University