Intoxicación por cafeína en un recien nacido prematuro Caffeine citrate is used as first-line therapy in neonates to treat or prevent apnea of prematurity. This is not the most recent version of this Review. Please comment on the current version. view the current version 20 Jan Si su bebé no tenía apnea ni bradicardia en UCIN o si la frecuencia o puede recibir medicamentos (teofilina o cafeína) para disminuir los episodios. Los bebés recién nacidos prematuros corren el riesgo de hernias, que.
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Serum levels of caffeine in umbilical cord and apnea of prematurity. Silveira II ;Renato S. To determine the influence of presence of cafejna in umbilical cord blood on apnea occurrence. A prospective cohort study with preterm newborns with birth weight lower than 2, g was undertaken.
Neonates were divided into detectable and undetectable caffeine in umbilical cord blood. Newborns were followed for the first 4 days for occurrence of apnea spells. Eighty-seven newborns with and 40 without detectable caffeine in umbilical cord blood were studied.
Median caffeine concentration of aphea 87 patients with detectable caffeine in umbilical blood was 2. There was no association between occurrence of apnea spells and presence of caffeine in umbilical cord blood.
Neonates with detectable caffeine in umbilical blood vafeina borderline later apnea Detected levels of caffeine in umbilical cord blood did not decrease occurrence of apnea of prematurity, but it had a borderline effect delaying its occurrence, suggesting that prematugo a low level of caffeine in umbilical cord blood might delay occurrence of apnea spells. Prematurity, apnea, caffeine, low-birth-weight pprematuro. Treatment of apnea of prematurity includes pharmacological approach with caffeine, a powerful stimulant of the central nervous system that reduces occurrence of neonatal apnea, promotes consolidation of a regular pattern of breathing and cafiena alveolar ventilation.
The role of maternal consumption of caffeine and occurrence of apnea in preterm neonates have aroused general interest. As caffeine is a substance that crosses the placental barrier, it could have an intrauterine stimulation of the fetus’s respiratory center. Caffeine is probably the most frequently drug taken in the world, consumed by people of all ages. This study aimed at determining the influence of presence of caffeine in umbilical cord blood on the incidence and time of occurrence of apnea of prematurity in the first dfl of life.
The sample was composed of preterm neonates with birth weight between 1, and 2, g and gestational age panea 37 weeks, born at HCPA between March and May The study excluded neonates whose mothers received opioids or drugs that anea to respiratory center depression, neonates who remained in mechanical ventilation during the first 4 days of life, with cerebral congenital malformations, perinatal asphyxia Apgar score under 7 at the 5th minute of lifePIVH degrees 3 and 4, major cardiac malformations, exchange transfusion before the fourth day of life, neonates who presented one isolated apnea with no need for drug or ventilatory treatment, and those that received methylxantine prior to extubation.
The method used in prwmaturo gestational age assessment was preferably the obstetric gestational age obtained through ultrasonography in the first weeks of fetal life or, if such data were unavailable, the date of most recent menstruation confirmed through clinical exam of the neonate.
Birth weight was measured using an electronic scale and the neonates were classified according to the curve of Alexander et al.
cafeína – English translation – Spanish-English dictionary
For the diagnosis of early sepsis, the study considered patients that presented clinical conditions and positive blood culture. All patients with diagnosis of sepsis were submitted to lumbar puncture. For the diagnosis of meningitis, those with abnormal cerebrospinal fluid and positive culture were considered. According ptematuro the service routine, preterm neonates whose birth weight was above 1, g and presented any clinical problem including apnea were submitted to CUS.
Echocardiogram was performed in all preterm neonates with clinical suspicion of PDA. Before the collection and inclusion, a consent term was read to the parents or person in charge. Preterm neonates who fulfilled the inclusion criteria had their umbilical venous blood collected, immediately after birth. They were monitored during their stay at neonatal intensive care unit for occurrence of apnea spells during the first 4 days of life. Diagnosis of apnea was performed through patient’s monitoring, and it was defined as interruption csfeina breathing for 20 s or more, or interruption of shorter duration if followed by cyanosis, hypotension or bradyarrhythmia.
Blood samples were collected from umbilical blood using syringes with heparin. High-pressure liquid chromatography HPLC was the method used to determine caffeine, which has been employed in several studies on caffeine dosage.
Group characteristics were analyzed using chi-square test, Fisher’s exact test, except for the birth weight variable Student’s t test and Apgar score Mann-Whitney test. Analysis of caffeine detection in blood employed the chi-square test. Umbilical blood was collected in preterm neonates; 21 of them were subsequently excluded seven for presenting apnea once with no need for treatment, five for remaining in mechanical ventilation until the fourth day of life, three for PIVH degrees 3 and 4, one for exchange transfusion, five for methylxantine prior to extubationand three cafina lost two due to insufficient sampled quantity for caffeine dosage and one due to family request.
The study population was constituted by neonates with mean gestational age of Group 1 was formed by 87 newborns and group 2 by Table 1 shows the group characteristics. Patients in group 2 had a statistically significant lower gestational age, and required more respiratory support CPAP and mechanical ventilation just after birth than those in group 1.
The logistic cwfeina model employed for the whole studied population took the presence of caffeine in umbilical cord blood as a dependent factor, and gestational age, occurrence of apnea, use of CPAP and mechanical ventilation as independent factors. None of them showed significance Table 3. Neonates with presence of caffeine in umbilical blood had borderline later apnea: This study showed that neonates with detectable and undetectable levels of caffeine in umbilical cord blood had similar occurrence of apnea, and among the neonates who presented apnea, occurrence was later in preterm neonates with detectable levels of caffeine.
In the group with no detected caffeine in umbilical cord blood, gestational age was significantly lower, and they required more respiratory support, suggesting a role for immaturity in this group of patients. Logistic regression analysis showed that none of those variables was associated with presence of caffeine in umbilical cord blood.
Some studies quantified maternal use of caffeine during pregnancy. Concentrations of caffeine and paraxanthine in saliva were measured in pregnant women in the United Kingdom levels of caffeine in plasma and saliva are strongly correlatedand the mean concentration of caffeine was 0. No difference was observed in occurrence of apnea between both groups, but diagnosis of apnea was obtained through pneumography, which was performed only after clinical stability and in patients that did not require ventilatory support or oxygen therapy, thus excluding patients with serious conditions.
In our study, caffeine detection rate and serum levels of caffeine were higher than the results of that study, probably because our population had higher caffeine ingestion.
One limitation of this study is the lack of comparison in the number of apnea spells between both groups. The first choice for treatment of apnea of prematurity in our unit is methylxantine, and its use would pdematuro the result. In a retrospective study that applied questionnaires on deel and caffeine consumption during and after pregnancy to mothers of infants with apnea before a polysomnography as part of the patient’s assessment determined that maternal caffeine and cigarette use during pregnancy was related to central apnea.
It was suggested that neonates chronically exposed to intrauterine caffeine could be more sensitive to occurrences of hypoxia. Experimental studies showed that recently born rats whose mothers had received caffeine during pregnancy had altered respiratory pattern.
Preterm infants with birth weight of cwfeina 1, g cafein with caffeine during the first 10 days have a reduced rate of bronchopulmonary dysplasia, and present a better neurodevelopmental outcome at 18 to 21 months than a control group.
In our study, detected levels of caffeine in umbilical cord blood did not decrease occurrence of apnea of prematurity, but it had a borderline effect delaying its occurrence, suggesting that even a low level of caffeine in umbilical cord blood might delay occurrence of apnea spells.
Methylxanthine treatment for apnea in preterm infants. Cochrane Database Syst Rev. Efficacy of caffeine in treatment of apnea in the low-birth-weight infant. Apnea is associated with neurodevelopmental impairment in very low birth weight infants.
Caffeine intake and prematurity. Assessing caffeine exposure in pregnant women. ABC of antenatal care. A United States national reference for fetal growth. Diagnosis and management of bacterial infections in the neonate. Pediatr Clin Dl Am. Evaluation of interleukin-6, tumour necrosis factor-alpha and prematurp for early diagnosis of neonatal sepsis. Apneq E, Bruguerolle B.
Simultaneous high-performance liquid chromatographic determination of caffeine and theophylline for routine drug monitoring in human plasma. J Chromatogr B Biomed Appl. A simple liquid chromatographic method applied to determine caffeine in plasma and tissues.
A rapid HPLC method for monitoring plasma levels of caffeine and theophylline using solid phase extraction columns. Simultaneous determination of caffeine and its primary demethylated metabolites in human plasma by high-performance liquid chromatography. The simultaneous determination of theophylline, theobromine and caffeine in plasma by high performance liquid chromatography.
Determination of caffeine, theophylline and theobromine in serum and saliva using high performance liquid chromatography. Apneaa acquired caffeine and the occurrence of apnea, bradycardia, and periodic breathing in preterm infants: Effects of maternal smoking and caffeine habits on infantile apnea: Consequences of in utero exposure on respiratory output in normoxic and hypoxic conditions and related changes of Fos expression: Perinatal respiratory control and its modulation by adenosine and caffeine in the rat.
Neonatal withdrawal symptoms after chronic maternal ingestion of caffeine. Caffeine therapy for apnea of prematurity.
N Engl J Med. Long-term effects of caffeine therapy for apnea of prematurity. Manuscript submitted Oct 20accepted for publication Jan 21 No conflicts of interest declared concerning the publication of this article. J Pediatr Rio J. Introduction Treatment of apnea of prematurity includes pharmacological approach with caffeine, a powerful stimulant of the central nervous system that reduces occurrence of neonatal apnea, promotes consolidation of a regular pattern of breathing and increases alveolar ventilation.
Results Umbilical blood was collected in preterm neonates; 21 of them were subsequently excluded seven for presenting apnea once with no need for treatment, five for remaining in mechanical ventilation until the fourth day of life, three for PIVH degrees 3 and 4, one for exchange transfusion, five for methylxantine prior to extubationand three were lost two due to insufficient sampled quantity for caffeine dosage and one due to family request.
“cafeína” in English
Discussion This study showed that neonates with detectable and undetectable levels of caffeine in umbilical cord blood had similar occurrence of apnea, and among the neonates who presented apnea, occurrence was later in preterm neonates with detectable levels of caffeine. Acknowledgements We thank Vania Naomi Hirakata for her assistance with the statistical analysis, and Carmen Pilla, BSc, for her assistance with the caffeine laboratory analysis.
Carlos Gomes, cj. Como citar este artigo.