1. 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 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 33
0.05
0.9542
Control
5.5 73
<
Reference 30
0.9563
OR for control group
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)