Caffeine Use for Apnea of Prematurity in Moderate and Late Preterm Infants: A Systematic Review

Objective: The objective is to perform a systemic review of the literature on the use of caffeine for the management of apnea of prematurity (AOP) in moderate and late preterm infants. Data Sources: In May 2016, we searched the following databases from the beginning of the year 1980: Medline, Embase, CENTRAL, CINAHL, ProQuest Dissertations and theses Global, and PubMed. Additional citations were searched in the clinical trial registries and from the bibliography of the selected articles. We updated our search in May 2018 to identify any new citations. Methods: Studies were included if they were randomized controlled trials (RCTs) involving preterm infants >= 32 weeks gestation and compared caffeine with placebo, reporting any of the prespecified clinical outcomes. Search strategies combined controlled vocabulary and keywords terms for apnea, caffeine, and preterm infants. No language restriction was applied. Two researchers independently reviewed the retrieved articles for inclusion. Disagreements were resolved by consensus among the review team. Results: The search strategy identified 839 citations after removing duplicates. We did not identify any published RCT that described the use of caffeine for AOP in moderate to late preterm infants. The updated search also did not identify an RCT. Conclusions: There is a lack of good quality evidence for the use of caffeine for the management of AOP in moderate and late preterm infants. An RCT is urgently needed to investigate the clinical benefits of caffeine use in this population and the potential savings in health-care resource utilization.