Caffeine Use and Brief Resolved Unexplained Events (BRUE) During the First Year of Life in Ex-Preterm Infants V. Mugarab-Samedi1, C. Fajardo1, H. Amin1,2, M. Baez 2, Y. Rabi1,2 Division of Neonatology, Department of Pediatrics, University of Calgary, Alberta, Canada University of Calgary, Alberta, Canada BACKGROUND Incidence of BRUE after 43 weeks postmenstrual age (PMA) does not differ between term and preterm infants No documented association between apnea of prematurity and the risk of BRUE Post-discharge caffeine is common in Calgary (altitude 1054m) KNOWLEDGE GAP Safety of discharging infants home on caffeine RESEARCH QUESTION Among preterm infants (P), does caffeine use post-discharge (I) compared no caffeine use(C) affect the incidence of BRUE (O) during first year of life (T)? PURPOSE A study utilizing home pulse oximetry recording to describe caffeine use and respiratory patterns launched January 2015 Main purpose of this study was to assess safety for current practice of discharging infants home on caffeine OBJECTIVE Examine the incidence of BRUE in this sample of ex-preterm infants, after discharge from hospital Examine frequency and etiology of illness requiring emergency room visits among this sample within 12 months post-discharge DESIGN AND METHODS Study Design: Observational prospective cohort study Inclusion Criteria: Infants born at ≤35 wks PMA Exclusion Criteria: No access to reliable post-discharge follow up, active serious medical conditions other than apnea, serious congenital disorders (e.g., genetic syndromes, midline defects, metabolic disorders) Intervention and Study Groups: Caffeine Group (A): born at ≤35 wks PMA discharged home with caffeine Control Group (B): born at ≤35 wks PMA discharged home without caffeine Reference Group (C): born at 36-37 wks PMA and did not require NICU admission Primary outcome: Incidence of BRUE during first year of life Secondary outcomes: ER visits within 12 months post-discharge, total number of hospital admissions, number of upper respiratory tract infections and reactive airway disease requiring hospital admission RESULTS Figure 1 Trial flow Table 1. Baseline characteristics of included infants * Feeding intolerance, Cow Milk Protein Intolerance( CMPA), Gastroesophageal Reflux Disease( GERD) Figure 2. Table 2. BRUE risk stratification Table 3. Statistics PRIMARY OUTCOME 4/136 infants had BRUE - All from Control Group and > 33 wks PMA STUDY LIMITATIONS Small sample size CONCLUSION We did not observe a higher risk of BRUE for ex-preterm infants discharged home on caffeine Closer monitoring of these infants after discharge warrants further investigation BRUE risk BRUE group N=4 Age <60 days, n 1 GA >32 wks , n 3 CGA < 45 weeks, n Repeated events, n Event Lasted > 1 minute, n CPR by trained medical provider, n 2 Concerning historical features, n Acute medical conditions, n 136 infants Caffeine group 33 infants 21 visits 11 infants 1 infant None Control group 73 infants 46 visits 25 infants 6 infants 6 episodes 4 infants Reference group 30 infants 12 visits 10 infants 3 infants ER visits in first 12 months Hospital admissions BRUE Groups BRUE proportion,% Sample size (n) Null Hypothesis,% p-value Caffeine 0.0000001 33 0.05 0.9542 Control 5.5 73 < 0.0001 Reference 30 0.9563 OR for control group - 0.25 Baseline Characteristics Reference Group N=30 Caffeine Group N=33 Control Group N=73 BRUE N=4 Male gender - n (%) 18 (60%) 20 (61%) 39 (53%) 3 (75%) Smokers in family - n (%) 1 (3%) 1(3%) 2 (2.7%) GA weeks, mean (SD) 37.4 (1.6) 30.6 (2.1) 31.7 (1.8) 28.3 (0.9) PMA at the time of event, mean (SD) NA 42.9 (1.7) Feeding problems * - n (%) 7 (23%) 15 (45%) 26 (36%) 1 (25%) Formula feeding >50% in first 3 months post discharge - n (%) 14 (47%) 17 (51%) 42 (57)