| Aim:Caffeine is widely used to treat apnea of prematurity.This study analyzed the early and late treatment of caffeine citrate in very low birth weight preterm infants and their outcomes.Here,we evaluated the efficacy of early caffeine in decreasing the incidence of adverse neonatal outcomes.Methods:A retrospective cohort was used to compare the neonatal morbidity of 73 preterm neonates admitted to and treated in the first affiliated hospital of nanchang university with gestational age ?32 weeks and birthweight <1500g,in the period from June 2015 to June 2019.Infants were divided into 3 groups based on the initiation timing of caffeine therapy;(1)early caffeine(0-2 DOL),(2)late caffeine(3-7 DOL),and(3)very late caffeine(? 8 DOL).To compare mechanical ventilation time,utilization ratethe,non-invasive ventilation time,total oxygen time,the use time caffeine,length of stayd and incidence of bronchopulmonary dysplasia(BPD),retinopathy of prematurity(ROP),necrotizing enterocolitis(NEC),Ventilator-associated pneumonia and the death rate.Results:1)The differences in mechanical ventilation time and utilization rate between the early caffeine,late caffeine and very late caffeine were statistically significant(P < 0.05).Further multiple comparisons showed that the differences in mechanical ventilation time and utilization rate between the early caffeine and late caffeine and very late caffeine were also statistically significant.2)The incidence of bronchopulmonary dysplasia(BPD)of early caffeine is lower,compared with the other two groups,the difference was statistically significant(0.19 vs 0.52 vs 0.85,P=0.000),Further multiple comparisons showedthat the incidence of bronchopulmonary dysplasia(BPD)of early caffeine is lower,compared with the other two groups,the difference was statistically significan.3)The incidence of infection of early caffeine is lower,compared with the other two groups,the difference was statistically significant(0.46 vs 0.36 vs 0.92,P=0.015),Further multiple comparisons showed that the incidence of infection of early caffeine is lower,compared with the very late groups,the difference was statistically significan(P=0.007 <0.017),But compared with late group,the difference was not statistically significan(P=0.596).4)The incidence of ventilator-associated pneumonia of early caffeine is lower,compared with the other two groups,the difference was statistically significant(0.22 vs 0.39 vs 0.69,P=0.007),Further multiple comparisons showed that the incidence of ventilator-associated pneumonia of early caffeine is lower,compared with the very late groups,the difference was statistically significan(P ? =0.005),But compared with late group,the difference was not statistically significan(P=0.238).5)The There was no statistically significant difference about the incidence of retinopathy of prematurity(ROP),necrotizing enterocolitis(NEC),intracranial hemorrhage,periventricular leukomalacia,Septicemia and mycosis and the death rate of three groups(P>0.05).6)Using binary Logistic regression model,univariate analysis without correction found that the risk of BPD was reduced in the early group compared with the late group(OR=0.214,95%CI :0.067-0.682,P=0.009).The risk of BPD was reduced in the early group compared with the very late treatment group(OR=0.042,95%CI :0.008-0.236,P=0.000).However,when factors such as gestational age,birth weight,critical mass score,mechanical ventilation time,invasive ventilation time,total oxygen use time,and total caffeine use time were included into the model,it was found that neither early caffeine treatment nor late or very late caffeine treatment had any influence on the occurrence of BPD(P > 0.05).7)Single factor analysis without correction showed that the risk of infection was lower in the early group than in the very late treatment group(OR=0.071,95%CI :0.008-0.602,P=0.015),and the risk of infection was lower in the late groupthan in the very late treatment group(OR=0.108,95%CI :0.012-0.978,P=0.048).However,after the inclusion of gestational age,critical care score,mechanical time,non-invasive time,length of stay,and caffeine use time into the binary logistic regression model,there was no influence on the occurrence of infection whether early caffeine treatment or late or late caffeine treatment(P >0.05).The risk of ventilator-associated pneumonia in the early group was lower than that in the very late treatment group(OR=0.123,95%CI :0.030-0.504,P=0.004).After adjusting for the above factors by binary logistic regression model,the risk of ventilator-associated pneumonia in the early group was lower than that in the very late group(AOR=0.137,95%CI :0.021-0.917,P=0.040)Conclusion:The results of this study showed that the use of citrate caffeine 0-2 days after birth in premature infants could reduce the use rate of mechanical ventilation and shorten the duration of mechanical ventilation.The risk of VAP in infants receiving caffeine after 8 DOL was respective of delayed treatment with caffeine,suggest that0-2 days after birth treated with caffeine.the risk for BPD has nothing to do with caffeine treatment time.in the early use of caffeine before treatment were introduced,suggested that further research. |
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