咖啡因是新生儿重症监护病房(NICU)中常规处方的药理活性化合物,用于治疗早产儿呼吸暂停(AOP)。这也降低了新生儿支气管肺发育不良和脑瘫的风险。咖啡因引起的过量钙流失可促进早产儿代谢性骨病(MBD)的发展。这项研究旨在评估咖啡因方案对早产儿骨质减少症(OOP)发展的影响。在生命的第4周使用血清碱性磷酸酶(serial-ALP)浓度作为替代标记。
这项回顾性队列研究包括胎龄<32周(GA)和出生体重<1500g的新生儿,从2017年4月至2018年12月入住NICU,并接受咖啡因治疗直至AOP存活28天。根据血清ALP水平,形成了高和低ALP组。新生儿特征,咖啡因方案,OOP的危险因素,包括肠外营养(PN)的持续时间,接触与MBD相关的药物,摄入必需的维生素和矿物质,在两组中进行比较。通过逻辑回归分析OOP的预测因素。
在总共268名参与者中,52(19%)开发了OOP,大部分为女性(61.5%)。在高ALP组中,血清ALP水平明显高于低ALP组(725.0±143.8vs273.6±55.0单位/L,p<0.001)。在本研究队列中,高ALP组的每日和累积咖啡因剂量显着(p<0.001)更高,并且与发生OOP的可能性更高相关[累积剂量(mg)(AOR=1.08295%CI1.011至1.157)和每日剂量(mg/kg/天)(AOR=2.89295%CI1.392至6.007)]。发现较小的GA与OOP直接相关。在其他医疗风险因素中,高ALP组的磷摄入量明显较低。不,PN的持续时间与类固醇和利尿剂的使用之间存在显着关系,并确定了维生素和矿物质的摄入量。
在本研究队列中,咖啡因和较小的GA的每日和累积剂量与OOP的发展有关。需要临床随机对照研究来验证结果并确定治疗早产儿AOP的最安全和最有效的咖啡因剂量范围。
Caffeine is a routinely prescribed pharmacological active compound in neonatal intensive care units (NICU) for treating apnea of prematurity (AOP), which also decreases the risk of bronchopulmonary dysplasia and cerebral palsy in neonates. Caffeine-induced excessive calcium loss can promote the development of metabolic bone disease (MBD) in preterm neonates. This study aimed to evaluate the effect of the caffeine regimen on the development of osteopenia of prematurity (OOP), using serum alkaline phosphatase (serum-ALP) concentrations as a surrogate marker at the 4th week of life.
This retrospective cohort study was conducted including neonates of < 32 weeks gestational age (GA) and birth weight < 1500 g, admitted to NICU from April-2017 to December-2018 and received caffeine therapy till 28 days of life for AOP. Based on serum-ALP levels, formed the high and low-ALP groups. Neonatal characteristics, caffeine regimen, risk factors for OOP, including duration of parenteral nutrition (PN), exposure to medicines associated with MBD, and intake of essential vitamins and minerals, were compared in both groups. Predictors of OOP were analyzed through logistic regression.
From the total of 268 participants, 52 (19%) developed OOP, mostly female (61.5%). In the high ALP group, the serum-ALP levels were significantly higher than in the low-ALP group (725.0 ± 143.8 vs 273.6 ± 55.0 units/L, p < 0.001). The high-ALP group received significantly (p < 0.001) higher daily and cumulative caffeine doses and were associated with a higher likelihood of developing OOP in this study cohort [cumulative dose (mg) (AOR = 1.082 95% CI 1.011 to 1.157) and daily dose (mg/kg/day) (AOR = 2.892 95% CI 1.392 to 6.007)]. Smaller GA was found directly related to OOP. Among the other medical risk factors, phosphorus intake was significantly low in the high-ALP group. No, significant relationship between duration of PN and use of steroids and diuretics, and intake of vitamins and minerals were identified.
The daily and cumulative doses of caffeine and smaller GA are associated with the development of OOP in this study cohort. Clinical randomized control studies are needed to validate the outcomes and determine the range of safest and most effective caffeine doses for treating AOP in preterm neonates.