Early caffeine therapy and clinical outcomes in extremely preterm infants

Objective:to determine if early caffeine (ec) therapy is associated with decreased bronchopulmonary dysplasia (bpd) or death, decreased treatment of patent ductus arteriosus (pda), or shortened duration of ventilation.study design:in a retrospective cohort of 140 neonates ⩽1250 g at birth, infants receiving ec (initiation <3 days of life) were compared with those receiving late caffeine (lc, initiation ⩾3 days of life) using logistic regression.result:of infants receiving ec, 25% (21/83) died or developed bpd compared with 53% (30/57) of infants receiving lc (adjusted odds ratio (aor) 0.26, 95% confidence interval (ci) 0.09 to 0.70; p<0.01). pda required treatment in 10% of ec infants versus 36% of lc infants (aor 0.28, 95%ci 0.10 to 0.73; p=0.01). duration of mechanical ventilation was shorter in infants receiving ec (ec, 6 days; lc, 22 days; p<0.01).conclusion:infants receiving ec therapy had improved neonatal outcomes. further studies are needed to determine if caffeine prophylaxis should be recommended for preterm infants.