521 - Respiratory Response to Caffeine Cessation: A Secondary Analysis of the MoCHA Trial

Publication Number: 3502.521

Colm P. Travers, University of Alabama at Birmingham, Birmingham, AL, United States; Arie Nakhmani, University of Alabama at Birmingham, Birmingham, AL, United States; Rachel L. Benz, UAB, Birmingham, AL, United States; Sandra M. Turner, University of Alabama at Birmingham, Birmingham, AL, United States; Namasivayam Ambalavanan, University of Alabama School of Medicine, Birmingham, AL, United States; Waldemar Carlo, University of Alabama, Birmingham, AL, United States

Background: Extending caffeine did not decrease the duration of hospitalization among moderately preterm infants in the MoCHA trial. While there was faster resolution of clinically-defined apnea events among infants randomized to extended caffeine, it is not known whether extended caffeine improved intermittent hypoxemia (IH) or bradycardia episodes.

Objective: To test the hypothesis that extended caffeine decreases IH and bradycardia episodes among MoCHA trial participants.

Design/Methods: Single center secondary analysis of a placebo controlled randomized trial of extending caffeine until 28 days after discharge among preterm infants 29-33 weeks' gestation. We compared episodes of IH and bradycardia of different depths and duration by randomization group. The primary outcome was the number of IH85, defined as oxygen saturations < 85% for 10 seconds or longer, episodes per day. Secondary outcomes included episodes per day of intermittent hypoxemia defined as < 80% for ≥10s, bradycardia defined as heart rate (HR) < 100 bpm for ≥10s and bradycardia defined as HR < 80 bpm for ≥10s. Vital sign data were collected from infant monitors using Bedmaster (Anandic, Switzerland). Continuous data were analyzed using Mann-Whitney U test comparing episodes by randomization group from 14 days before until 14 days after the day of randomization (29 days total).

Results: We included 103 infants (53 randomized to extended caffeine versus 50 controls). There was a significant difference in intermittent hypoxemia episodes per hour with SpO2 < 85% for ≥10s between groups (caffeine median±SD, 0.39±0.07 versus control 0.64±0.32; p< 0.001) (Table 1, Figure 1). Intermittent hypoxemia episodes per hour with SpO2 < 80% for ≥10s also differed significantly between groups (Table1, Figure 1). Episodes of bradycardia per hour with HR < 100 bpm for ≥10s and episodes of bradycardia per hour with HR < 80 bpm for ≥10s differed significantly between groups (Table 1, Figure 2).

Conclusion(s): Extended caffeine was associated with fewer episodes of hypoxemia and bradycardia prior to discharge home among moderately preterm infants.

Figure 1
Intermittent hypoxemia episodes per hour per day by randomization group (Blue = extended caffeine and Orange = control). Day 0 represents day of randomization.

Figure 2
Bradycardia episodes per hour per day by randomization group (Blue = extended caffeine and Orange = control). Day 0 represents day of randomization.

Table 1
Median episodes of intermittent hypoxemia with SpO2 <85% for more than 10 seconds (IH85) with SpO2 <80% for more than 10 seconds (IH80) and bradycardia with heart rate <100 bpm for > 10 seconds (HR100) and bradycardia with heart rate less than 80 for >10 seconds (HR80).