J Korean Med Sci.  2018 Jan;33(4):e25. 10.3346/jkms.2018.33.e25.

Hemodynamic Effects on Systemic Blood Flow and Ductal Shunting Flow after Loading Dose of Intravenous Caffeine in Preterm Infants according to the Patency of Ductus Arteriosus

• Hwang J
• Kim YS
• Shin JH
• Choi BM

• KMID: 2400643
• DOI: http://doi.org/10.3346/jkms.2018.33.e25

Abstract

BACKGROUND
In preterm infants, caffeine citrate is used to stimulate breathing before they are weaned from mechanical ventilation and to reduce the frequency of apnea. In recent studies, effects of caffeine on the cardiovascular system have been emphasized in preterm infants with patent ductus arteriosus (PDA).
METHODS
This study aimed to assess the short-term hemodynamic effects on systemic blood flow and ductal shunting flow after loading standard doses of intravenous caffeine in preterm infants. Echocardiographic studies were performed by a single investigator, before and at 1 hour and 4 hours after an intravenous infusion of a loading dose as 20 mg/kg caffeine citrate for 30 minutes.
RESULTS
In 25 preterm infants with PDA, left ventricular output decreased progressively during 4 hours after caffeine loading. Superior vena cava (SVC) flow decreased and ductal shunting flow increased at 1 hour and then recovered at 4-hour to baseline values. A diameter of PDA significantly decreased only at 4-hour after caffeine loading. There were no significant changes of these hemodynamic parameters in 29 preterm infants without PDA.
CONCLUSION
In preterm infants with PDA, a standard intravenous loading dose of 20 mg/kg caffeine citrate was associated with increasing ductal shunting flow and decreasing SVC flow (as a surrogate for systemic blood flow) 1 hour after caffeine loading, however, these hemodynamic parameters recovered at 4 hours according to partial constriction of the ductus arteriosus. Close monitoring of hemodynamic changes would be needed to observe the risk for pulmonary over-circulation or systemic hypo-perfusion due to transient increasing ductal shunting flow during caffeine loading in preterm infants with PDA.

Keyword

Caffeine; Echocardiography; Ductus Arteriosus, Patent; Infant, Premature

MeSH Terms

Apnea
Caffeine*
Cardiovascular System
Citric Acid
Constriction
Ductus Arteriosus*
Ductus Arteriosus, Patent
Echocardiography
Hemodynamics*
Humans
Infant, Newborn
Infant, Premature*
Infusions, Intravenous
Research Personnel
Respiration
Respiration, Artificial
Vena Cava, Superior
Caffeine
Citric Acid