title: A pilot randomized trial of high-dose caffeine therapy in preterm infants.
abstract: BACKGROUND
  Standard-dose caffeine improves white matter microstructural development assessed by diffusion magnetic resonance imaging (MRI). We hypothesized that early high-dose caffeine would result in further improvement in white matter microstructural development.
  
  
  METHODS
  Seventy-four preterm infants (≤30 wk gestational age) were randomly assigned to either a high (80 mg/kg i.v.) or standard (20 mg/kg i.v.) loading dose of caffeine citrate in the first 24 h of life. MRI and neurobehavioral testing were undertaken at term equivalent age. Infants returned at 2 y of age for developmental testing.
  
  
  RESULTS
  Clinical characteristics were similar between groups, with the exception of higher maternal age in the high-dose caffeine group. There was an increased incidence of cerebellar hemorrhage in infants randomized to high-dose caffeine (36 vs. 10%, P = 0.03). Infants in the high-dose caffeine group also demonstrated more hypertonicity (P = 0.02) and more deviant neurologic signs (P = 0.04) at term equivalent age. Diffusion measures at term equivalent age and developmental outcomes at 2 y of age did not differ between groups.
  
  
  CONCLUSIONS
  Preterm infants randomized to early high-dose caffeine had a higher incidence of cerebellar injury with subsequent alterations in early motor performance. The results of this pilot trial discourage a larger randomized controlled trial.
authors: 1] Department of Pharmacy, Brigham and Women's Hospital, Boston, Massachusetts [2] Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Christopher
authors: C
authors: McPherson
authors: Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.
authors: Jeffrey J
authors: JJ
authors: Neil
authors: Department of Pediatrics, University of Hawaii, Honolulu, Hawaii.
authors: Tiong Han
authors: TH
authors: Tjoeng
authors: 1] Program in Occupational Therapy, Washington University in St. Louis, St. Louis, Missouri [2] Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri.
authors: Roberta
authors: R
authors: Pineda
authors: Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Terrie E
authors: TE
authors: Inder
mesh_terms: D002110:Caffeine / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008279:Magnetic Resonance Imaging; D010865:Pilot Projects; D066127:White Matter / Q000187:drug effects
chemical_list: D002110:Caffeine