Caffeine use in preterm neonates: national insights into Turkish NICU practices
Authors: Unal Sezin , Beken Serdar , Anuk Ince Deniz , Turan Ozden , Korkmaz Toygar Ayse , Ecevit Ayse , Akcan Abdullah Baris , Akın Mustafa Ali , Aktas Selma , Ciftdemir Nukhet Aladag , Altuncu Emel , Altunhan Huseyin , Arcagok Baran Cengiz , Armangil Didem , Arun Ozer Esra , Aydın Banu , Bezirganoglu Handan , Bilgin Leyla , Calısıcı Erhan , Calkavur Sebnem , Celik Kıymet , Celik Yalcın , Cetinkaya Bilin , Cetinkaya Merih , Demirel Atalay , Demirel Gamze , Dogan Nazan Neslihan , Doğan Pelin , Durukan Mehtap , Engur Defne , Erener Ercan Tugba , Gokmen Zeynel , Guney Varal Ipek , Gulası Selvi , Gunlemez Ayla , Gursoy Tugba , Hakyemez Toptan Handan , Hamitoğlu Serif , Isleyen Fatih , Iyigun Irem , Kader Sebnem , Kahvecioğlu Dilek , Kaykı Gozdem , Kostu Murat , Kurnaz Dilek , Mammadalıyev Tural , Mungan Akin Ilke , Narlı Nejat , Okulu Emel , Okur Nilufer , Olukman Ozgur , Ovalı Fahri , Ozcan Beyza , Ozdemir Ahmet , Ozdemir Ozmert , Ozkan Hilal , Sandal Gonca , Sarıcı Dilek , Sivrikaya Cansu , Siyah Bilgin Betul , Sundus Saime , Surmeli Onay Ozge , Simsek Huseyin , Tandırcıoğlu Umit Ayse , Tanrıverdi Sema , Tekgunduz Kadir Serafettin , Terek Demet , Tunc Gaffari , Tunc Turan , Tutak Ercan , Tufekcioğlu Eda , Tuzun Erdogan Funda , Ulu Ersin , Ulubas Isik Dilek , Uras Nurdan , Uslu Sait Ilker , Unal Irem , Yılmaz Fatma Hilal , Moniri Ariorad 
Published: February 2025

Objective

Caffeine is a proven medication used for the prevention and treatment of apnea in premature infants, offering both short- and long-term benefits. International guidelines provide a range of recommendations regarding the preterm population eligible for caffeine prophylaxis, including the timing, dosage, and duration of treatment. Our national guidelines, published prior to the most recent updates of the international guidelines, recommend the use of caffeine citrate starting from the first day after delivery for preterm infants with a gestational age of &lt;28 weeks. For infants up to 32 weeks, if positive pressure ventilation is required, the decision should be made on an individual basis. This study aims to describe the variability in caffeine usage across neonatal intensive care units in our country.

Methods

An online survey was sent to neonatologist who are members of the Turkish Neonatology Society to describe the variability in caffeine usage in neonatal intensive care units in our country.

Results

We collected responses from 74 units. Prophylactic caffeine usage was observed as; GA ≤276/7: 98.6%, GA 280/7–286/7: 89.0%, GA 290/7–296/7: 75.3%, GA 300/7–316/7: 53.4%. 62.2% of units reported administering loading dose within the first two hours. The initial maintenance dose was 5 mg/kg in 64.8% of units, 10 mg/kg in 32.4% of units, and intermediate dose in 5.3% of units. 47.3% of units reported no routine dose adjustment. The postmenstrual age that caffeine treatment was stopped was found to be 34 (min-max; 32–36) weeks for infants without apnea and respiratory support, 36 (min-max; 34–52) weeks for infants without apnea but any respiratory support. The time to discharge after treatment cessation was found as; 1–4 days: 37.8%, 5–7 days: 68.9%. Among the 56 units with multiple responsible physicians, 32.1% reported intra-unit variations.

Conclusion

The significant differences in caffeine usage characteristics between and within units highlight the need for clear recommendations provided by standardized guidelines.