Caffeine Citrate for the Treatment of Apnea Associated With Bronchiolitis in Young Infants
Viral bronchiolitis is the most common lower respiratory tract infection of infancy. Apnea is a complication of bronchiolitis, reported in 16 - 21% of cases. Caffeine, a trimethylxanthine, acts as an antagonist to endogenous adenosine and a potent central nervous system stimulant. In apnea of prematurity, caffeine is believed to work by increasing central respiratory drive.
Infants ≤4 months of age, presenting to pediatric emergency center Al-Sadd, from September 2011 to May 2014, with a diagnosis of viral bronchiolitis associated with apnea.
A randomized, double-blind, controlled trial with a sample size of 45 patients per group
Data Collection methods, instruments used measurements:
In the emergency department, the patients will be assigned to either one of the two treatments using a computer-generated randomized numbers in a 1:1 ratio. Pharmacy will prepare sequential sealed vials containing the experimental drugs. Randomization code will be revealed only after all patients completed the study. The medical team in addition to the patients will be blinded to the medication delivered. There will be no detectable difference in the color, smell of the two study treatments.
Guardians or parents of eligible infants will be approached regarding the study, explaining the purpose and the treatment modalities. Patients will be included after obtaining a verbal and written consent.
Treatment 1: Single stat dose (25 mg per kilogram of body weight) of intravenous caffeine citrate (25mg caffeine citrate equal to 12.5mg caffeine base).
Treatment 2: Placebo with an equivalent volume of normal saline. Calculated study medications will be diluted with Dextrose 5% in Water to 20 ml and will be given intravenous over 30 minutes using syringe infusion pump.
After random assignment, eligible infants will receive one of the study treatments. Non-pharmacological therapies may be used as necessary to control apnea. Antibiotics and antipyretics may be used as per the discretion of the treating physician.
After stabilization of patients as usually done in Pediatric Emergency Center , patients will be admitted to pediatric intensive care unit (PICU) for further monitoring monitoring when indicated.
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator)
Primary Purpose: Treatment
|Official Title:||Caffeine Citrate for the Treatment of Apnea Associated With Bronchiolitis in Young Infants: A Randomized, Double Blind, Controlled Trial (RCT)|
- The primary efficacy outcome in this double-blinded study was the time until last apnea episode in both groups. [ Time Frame: 2 year 8 mongths ]
- The proportion of patients with apnea resolution at 12 hours in both groups, [ Time Frame: 2 year and 8 months ]
- The frequency of apnea in the first 24, 48 and 72 hours after medication administration for both arms [ Time Frame: 2 year and 8 months ]
- The duration of apnea in the first 24, 48, and 72 hours after medication administration for both arms [ Time Frame: 2 year and 8 months ]
- Invasive and non-invasive respiratory support needed in both groups. [ Time Frame: 2 year 8 months ]
- The length of oxygen therapy needed in both groups. [ Time Frame: 2 year 8 months ]
- The time until feeding was tolerated in both groups. [ Time Frame: 2 year 8 months ]
- The length of PICU/step-down unit stay in both groups. [ Time Frame: 2 year 8 months ]
- The overall length of hospital stay in both groups. [ Time Frame: 2 year 8 months ]
- Spot heart rate in both groups was compared every 4 hours from enrollment for up to three days. [ Time Frame: 2 year 8 months ]As a safety measure, spot heart rate was compared every 4 hours from enrollment for up to three days.
|Study Start Date:||November 2011|
|Study Completion Date:||November 2014|
|Primary Completion Date:||May 2014 (Final data collection date for primary outcome measure)|
|Active Comparator: caffeine Citrate||
Drug: Caffeine citrate
Single stat dose (25 mg per kilogram of body weight) of intravenous caffeine citrate (25mg caffeine citrate equal to 12.5mg caffeine base).
Other Name: arm 1
|Placebo Comparator: Normal saline||
Drug: Normal saline
Placebo with an equivalent volume of normal saline.
Other Name: arm2
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Please refer to this study by its ClinicalTrials.gov identifier: NCT01435486
|Pediatric emergency center, Hamad Medical Corporation|
|Doha, Qatar, 3050|
|Principal Investigator:||dr. Khalid Al-ansari, MD,FAAP||consultant pediatric emergency|