Prem Fort
United Kingdom, Johns Hopkins University School of Medicine, United KingdomTitle : Caffeine for apnea of prematurity; past, present, and future
Abstract
Annually, 15
million babies are born premature worldwide. In the United States alone, 1 out
of 10 babies are born premature every year. This leads to a healthcare cost of
approximately $26 billion per year in the US. Apnea of prematurity is one of
the most common diagnosis in preterm infants, affecting up to 50% of infants
born less than 32 weeks and practically all premature infants of gestational
ages below 28 weeks at birth. Caffeine has been the standard of care for the management
of apnea in preterm infants for decades, with the largest trial published in
2006. Caffeine works by blocking adenosine receptors in the brain, which
ultimately lead to improved signaling and other of the respiratory center and
other respiratory mechanisms in preterm infants. Caffeine doses have increased
nearly every decade and the way caffeine has been given has also varied in
clinical practice. Many years after it was first used, we are still unsure of
the optimal dose or timing of caffeine. Although the safety profile of caffeine
is wide and generally considered safe, even in the smallest of infants, as
doses have increased, there is caution from the pediatric and neonatal
community as to possible deleterious effects of high doses of caffeine,
affecting cerebral perfusion and ultimately long term neurodevelopment.
However, higher doses have been linked to improved respiratory outcomes in the
same population. We review the studies historical use of caffeine to treat AoP
as well as recent studies evaluating current and higher doses; Caffeine, its
past, present, and future.
Biography
Dr. Fort is the chair for the research council at the Maternal, Fetal, and Neonatal institute at Johns Hopkins All Children’s Hospital. He is a board-certified pediatrician and neonatologist with a research focus in respiratory medicine in preterm infants. He attended completed his pediatrics training at Duke University Medical Center, and Neonatal-Perinatal fellowship at the University of Alabama in Birmingham. He has successfully presented research studies at the National Child Health and Human Development (NICHD) and has been and is currently involved in a multitude of multicenter, regional and national clinical trials. He is recognized nationally and internationally as an expert in respiratory care with minimally invasive methods of surfactant administration, a drug that is needed for preterm infants to breath. He serves on international committees and is a member of editorial board and expert reviewer of reputed journals.
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