Effect Of Different Timing Of Caffeine Citrate Administer On The Short-Term And Long-Term Outcomes Of Premature Infants

In recent years,with the increasing maturity of perinatal technology and the improvement of treatment level in newborns,especially premature infants,more and more very early premature infants and very low birth weight infants have survived.However,due to immature development of various organ systems of premature infants,especially respiratory center system,imperfect connection between respiratory center tissue structure and neurons,and weak nerve impulse transmission,premature infants are prone to respiratory regulation disorder,which causes apnea,hypoxia,acidosis and so on,thus causing adverse outcomes and reducing long-term quality of life.Therefore,it is very important for clinical workers to reduce the occurrence of complications and improve the long-term prognosis while saving the life of premature infants.Caffeine citrate is a methylated xanthine derivative,which can reduce apnea of prematurity(AOP)by stimulating respiratory center and promoting diaphragmatic contraction.It has been widely used in neonatal intensive care unit and has become one of the most commonly drugs for clinical workers.In the process of application,more and more researchers have found that caffeine can not only cure the apnea,also can reduce the mechanical ventilation time and the incidence and mortality of bronchopulmonary dysplasia(BPD),had an influence on the short-term and long-term quality of life of premature infants through the corresponding lung protection and brain protection mechanisms.It can be seen that the correct and reasonable application of caffeine citrate may play an important role in the prevention and treatment of related complications in premature infants.After more than 40 years of changes,the current practice of caffeine citrate in premature infants has accumulated a lot of clinical experience,the relevant medication guidelines are constantly revised,but there are still some problems to be solved,such as the timing of caffeine administration and the choice of dosage,etc.The objective of this study is to explore the effect of early preventive administration caffeine citrate on the short-term and long-term outcomes of preterm infants,and to further guide clinical medication.Objective1.To explore the timing of caffeine citrate administer in premature infants and its relationship with premature infant outcomes.2.To follow up and analyze the effect of caffeine citrate on the neurodevelopment of premature infants at different times.Materials and methods144 premature infants with gestational age of less than 32 weeks and body weight of less than 1500g admitted to the neonatal intensive care unit(NICU)of the Third Affiliated Hospital of Zhengzhou University from January to August 2018 were selected as the research objects.According to the random number table method,they were divided into prevention treatment group and routine treatment group,and the last 139 cases were included in the study.The preventive treatment group(n=69)used caffeine citrate prophylactically within 24 hours after birth,while the routine treatment group(n=70)started to use caffeine after the occurrence of primary apnea.The basic perinatal conditions,treatment process and clinical outcomes of the two groups of children were counted and analyzed.At the corrected gestational age 40 weeks,these children were assessed with the neonatal behavioral neurological assessment(NBNA).At the corrected gestational age 3 months and 12 months,these children were assessed by the Chinese children’s Development Center(CDCC)’s developmental scale.Finally,these data were recorded and analyzed.All data were analyzed using SPSS22.0 statistical software.The measurement data were expressed in terms of mean± standard deviation((?)),and the t-test was used for the comparison of means between the two groups.The counting data were expressed as percentage(%),and the rate was compared by χ2-test.And P<0.05 was statistically significant.Results1.There was no significant difference in gender,birth gestational age,birth weight,conception and mode of birth,postnatal score of Apgar,prenatal administration of glucocorticoid,maternal high risk factors,etc.(P>0.05).The general condition of the two groups of children was comparable.2.After treatment,the results showed that there were no significant differences in the course of treatment,apnea disappearance time,endotracheal intubation rate within one week and non-invasive mechanical ventilation time between the two groups(all P>0.05),while the invasive mechanical ventilation time,oxygen therapy time and hospitalization days in the prevention group were lower than those in the conventional treatment group(all P<0.05).3.There was no significant difference in mortality rate,retinopathy of prematurity(ROP),necrotizing enterocolitis(NEC)and severe intraventricular hemorrhage(IVH)between the two groups(all P>0.05),while the incidence rate of BPD and patent ductus arteriosus(PDA)in the prevention group was lower than that in the conventional treatment group(all P<0.05).4.The NBNA score of the prevention group from corrected gestational age to 40 weeks was 38.5±1.6 points,and that of the conventional treatment group was 35.7±2.2 points.The NBNA score of the prevention group was higher than that of the conventional treatment group(t=4.76,P<0.05).The follow-up results showed that the Mental Developmental Index(MDI)of the prevention group at 3 months of corrected gestational age was higher than that of the conventional treatment group,and the Mental Developmental Index and Psychomotor Developmental Index(MDI/PDI)of the corrected gestational age to 12 months were higher than that of the conventional treatment group(P<0.05).Conclusions1.Early preventive administration of caffeine citrate can reduce the duration of invasive mechanical ventilation,oxygen therapy and the incidence of BPD and PDA.2.Early preventive administration of caffeine citrate can improve the neurological prognosis of premature infants to some extent.