Caffeine treatment for bronchiolitis-related apnea in the pediatric intensive care unit - 25/11/19

Doi : 10.1016/j.arcped.2019.10.009

N. Heuzé ^a,^b,^c, I. Goyer ^d, F. Porcheret ^a, M. Denis ^a, C. Faucon ^a, M. Jokic ^a, D. Brossier ^a,^e,^f,^g,⁎
^a CHU de Caen, Pediatric Intensive Care Unit, 14000, Caen, France
^b CHU de Caen, Pediatric Emergency Department, 14000, Caen, France
^c CH de Lisieux, Department of Pediatrics, 14000, Lisieux, France
^d CHU de Caen, Department of Pharmacy, 14000, Caen, France
^e Université Caen Normandie, Medical School, 14000, Caen, France
^f CHU Sainte Justine Research Institute, CHU Sainte Justine, Montreal, Canada
^g Laboratoire de Psychologie Caen Normandie, Université Caen Normandie, 14000, Caen, France

^⁎Corresponding author at: Service de réanimation pédiatrique, 3^e étage bâtiment FEH, CHU de Caen, avenue de la côte de Nacre, 14033 Caen, France.Service de réanimation pédiatrique, 3^e étage bâtiment FEH, CHU de Caenavenue de la côte de NacreCaen14033France

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Monday 25 November 2019
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Abstract

Introduction

Apnea is commonly encountered in children with bronchiolitis. Despite the lack of recommendations regarding bronchiolitis-related apnea (BRA) management, some pediatric intensive care unit (PICU) practitioners use caffeine treatment based on extrapolation from the recommendations for prematurity-related apnea management. The objectives of this study were to describe the management of BRA in our PICU, evaluate the caffeine prescription rate for this indication, and explore its potential effects on clinical outcomes.

Methods

This was a retrospective study in a university hospital PICU between January 1st, 2009 and December 31st, 2016. All children under 1 year of age admitted to the PICU with a diagnosis of BRA were included. Patients were allocated to a control group or a caffeine group depending on the administration of caffeine.

Results

In total, 54 infants were included and caffeine treatment was administered to 49 (91%) of them. Patient characteristics were similar between the two groups. Ventilatory support was initiated for 50 patients (93%). Supportive care and length of PICU stay were similar between the two groups. Caffeine was not associated with adverse events.

Conclusion

Caffeine treatment in BRA could be considered as a local standard practice. This retrospective study was underpowered to show any benefit of caffeine treatment on clinical outcomes. This treatment was not associated with significant adverse effects. We raised the question of the appropriate caffeine dosing regimen for BRA in this postterm population. Further studies on this topic are warranted.

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Keywords : Bronchiolitis, Apnea, Caffeine, Intensive care