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  • Title: The effect of caffeine citrate on neural breathing pattern in preterm infants.
    Author: Parikka V, Beck J, Zhai Q, Leppäsalo J, Lehtonen L, Soukka H.
    Journal: Early Hum Dev; 2015 Oct; 91(10):565-8. PubMed ID: 26217936.
    Abstract:
    BACKGROUND: Caffeine citrate is widely used to prevent and treat prematurity-associated apnea. AIMS: The aim of this study was to characterize the effect of caffeine citrate on the neural control of breathing, especially central apnea, in premature infants. STUDY DESIGN: Preterm infants were evaluated for 30min before and 30min after caffeine citrate loading (20mg/kg). A feeding tube including miniaturized sensors was used to measure the diaphragm electrical activity (Edi) waveform. Central apnea was defined as any period where the Edi waveform was flat for >5s. SUBJECTS: Seventeen preterm infants with a mean age of three days and mean birth weight of 900 grams were evaluated. OUTCOME MEASURES: In addition to central apnea, several parameters including neural inspiratory time, neural respiratory rate, peak Edi, delta inspiratory change in Edi (phasic Edi) and minimum Edi on exhalation were measured. RESULTS: The majority of the apnea were short (5 to 10s) and the number of apnea correlated with birth weight (p=0.039). Caffeine citrate reduced significantly the number of 5-to-10-second-long central apnea during the 30-minute periods (12±11 to 7±7; p=0.02). Caffeine citrate increased both peak and phasic Edi leading to a significant increase in the diaphragm energy expenditure. CONCLUSIONS: Edi signal can be reliably measured and processed to study changes in premature infants' neural breathing. The beneficial effect of caffeine citrate on the reduction of the number of apnea is mediated through stimulated neural breathing increasing the diaphragm energy expenditure.
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