الفهرس 
Respiratory Distress SyndromeOnly 14 pages are availabe for public view
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Abstract
Caffeine is a stimulant of the respiratory center and has been used for the treatment of Apnea of Prematurity in infants not requiring mechanical ventilation or to facilitate weaning from mechanical ventilation by starting therapy shortly before extubation. Recently the use of Caffeine in ventilated infants has been initiated earlier because of the reported reduction in BPD. However there is paucity of data supporting this practice (Eduardo Bancalari, 2015).
Weaning from support may be prolonged or, even if extubation is achieved, frequent episodes of apnea may occur in association with respiratory failure (hypercarbia, hypoxaemia and acidosis) of sufficient severity as to lead to reintubation and the use of IPPV. As a consequence, the use of IPPV is prolonged with associated costs for higher dependency care and a potential for morbidity from the intervention (JohnWiley, 2013).
When preterm infants have been given intermittent positive pressure ventilation (IPPV) for respiratory failure, weaning from support and tracheal extubation may be difficult. A significant contributing factor is thought to be the relatively poor respiratory drive and tendency to develop hypercarbia and apnea, particularly in very preterm infants. At any given gestational age the tendency to develop apnea decreases with increasing postnatal age (Henderson-Smart and Davis, 2006).
Because protracted mechanical ventilation and supplemental oxygen increase the risk of developing BPD, a therapy that would facilitate the reduction of the respiratory support and shorten its duration is desirable. Therefore, it is of importance to evaluate the effects of early Caffeine initiation and administration during the course of mechanical ventilation in preterm infants (Eduardo Bancalari, 2015).
Our study included 60 pre terms less than 37 weeks and less than or equal to 2kg. They were then divided into two group case and control each group compromised of 30 neonates. We excluded any neonate with a congenital anomaly.
The cases group was given caffeine citrate at day 1 of mechanical ventilation. A loading dose of 20mg/kg /day followed by maintenance dose 5mg/kg/day was administrated either orally or intravenously as determined by clinical team responsible for each case. Drug was given till after the baby is removed fully from any oxygen support.
The remaining 30 preterms were also on mechanical ventilation from day 1 but were not given any caffeine citrate.
All patients were subjected to the following:
1. Full maternal history taking
2. Thorough clinical examination including
3. Recorded APGAR score at 1st&5th minutes and full resuscitation history
4. CBC,CRP, Chemistry, PT & PTT at admission
5. ABG at day 1 of mechanical ventilation on SIMV mode
6. A second ABG was taken after the end of the first week and ventilator setting and mode were recorded.
7. A third ABG taken after the second week and ventilator setting and mode were recorded.
Cases and control were then compared as regards to outcome (number of death and number discharged), number of days in which each group stayed on mechanical ventilation, oxygen support and total oxygen duration of each group. And comparison between different modes of ventilation at each stage the ABG was withdrawn.
We found out that there is no significant difference between each group as regard to days on oxygen support after extubation. However there was a significant difference between total days on mechanical ventilation where cases had much lower days on mechanical ventilation than the control group which resulted in a significant difference between total oxygen duration between the two groups.
Ventilator mode recorded on second and third stage there was a significant difference between the two groups where the case group had a lesser invasive mode in both stages than the control group.
Relapse due to apnoea the case group had a lower number of relapse due to apnoea than the control group.
Outcome between the two groups was also significant where the case group had a much lower number of death and higher number of discharged patients than the control group.
Conclusion our study has shown that caffeine citrate does increase the chance of successful extubation which leads to lower oxygen duration therefore reducing complications of prolonged oxygen duration. According to our study caffeine citrate also improves outcome as regards to death rate and discharge rate.