Introduction
Caffeine has demonstrated effectiveness in reducing neonatal apnea in certain settings. However, previous studies on its use for bronchiolitis-related apnea (BRA) have been limited by small sample sizes and inconsistent findings. This study aimed to evaluate the impact of caffeine on BRA using data from a multicentre database.
Method
This study was a multicentre retrospective analysis utilizing the Paediatric Health Information Systems database. It included patients under two years of age who were admitted between January 1, 2010, and December 31, 2023, with ICD codes for bronchiolitis and apnea. Daily billing records were analysed to identify patients who received caffeine, non-invasive ventilation (NIV), and invasive mechanical ventilation (IMV). To assess the impact of caffeine on IMV use, encounters where caffeine was administered before IMV were propensity matched (4:1 nearest-neighbour) for caffeine prescription. The marginal risk ratio for IMV was then calculated in the matched cohort. A nested sensitivity analysis was performed, excluding patients with neonatal or cardiovascular complex chronic conditions.
Key Findings
- Total Admissions: 7,655 admissions among 7,562 patients across 48 hospitals for BRA.
- Caffeine Use: 9.9% (756/7,655) received caffeine; 82.3% (622/756) received caffeine before IMV.
- Trend Over Time: Caffeine use declined from 12.4% in 2010 to 4.3% in 2023 (p < 0.001).
- Baseline Differences: Before matching, caffeine users were younger, had more chronic conditions, and were more likely to require ICU admission and NIV.
- Matching Performance: Excellent, with an average pair distance of 0.0038.
- Effect on IMV: After matching, caffeine use was associated with reduced IMV risk (MRR = 0.861 [95% CI 0.762-0.972], NNT = 21.3).
- Sensitivity Analysis: Excluding neonatal/cardiovascular conditions (68.9% of cohort) showed similar results but with wide confidence intervals (MRR = 0.824 [95% CI 0.681-0.997], NNT = 19.4).
Conclusion
Caffeine use was linked to a decreased need for IMV in patients with BRA based on this retrospective database analysis. However, the wide confidence intervals in the effect size estimate indicate the need for further research.
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