Caffeine for the Treatment of Apnea in Bronchiolitis: A Randomized Trial

What is it about?

OBJECTIVE: To evaluate the efficacy and safety of caffeine citrate in the treatment of apnea in bronchiolitis. STUDY DESIGN : Eligible infants < 4 months of age presenting to the main pediatric emergency service with apnea associated bronchiolitis were stratified by gestational age (<34 weeks or longer) and randomized to receive a single dose of intravenous 25 mg/kg caffeine citrate or saline placebo. The primary efficacy outcome was a 24-h apnea-free period beginning after blinded study drug infusion. Secondary outcomes were frequency of apnea by 24, 48 and 72 hours after study medication, need for noninvasive/invasive ventilation, and length of stay in the hospital PICU/Step-down unit. RESULTS: 90 infants diagnosed with viral bronchiolitis associated with apnea, median age 38 days, were enrolled. Over 60% had apnea observed both at home and/or before treatment in the emergency department. Respiratory virus positivity was similar (78% vs 84%) in each group. Geometric mean duration until resolution of apnea was 28.1 h (95% CI, 25.6 to 32.3 h) and 29.1 h (95% CI, 25.7 to 32.9 h) for caffeine and placebo respectively, p=0.88, ratio 0.99 (95% CI, 0.8 to 1.17). Frequency of apnea at 24, 24-48 h, and 48-72 h after enrollment and need for noninvasive and invasive ventilation were similar for both groups. No safety issues were reported. Conclusions: A single dose of caffeine citrate did not significantly reduce apnea episodes associated with bronchiolitis.

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