Reports From The Field-Pediatrics

Docs underestimate preterm babies' survival rates

Obstetricians and pediatricians who are pessimistic about the outcomes of premature infants tend to underestimate their actual chances of survival and freedom from serious disability, says a recent study in Pediatrics. Physicians who are most pessimistic about such infants' outcomes are least likely to use potentially lifesaving therapies, researchers conclude.

Researchers surveyed 379 obstetricians and 362 pediatricians about their knowledge of survival and disability rates of infants born at 23 to 36 weeks of gestation and whether they would provide therapeutic interventions either to the expectant mother or infant. Pessimists significantly underestimated survival and disability-free rates for the premature infants, while optimists provided more accurate estimates, researchers found.

Specific findings include:

• Optimistic pediatricians were 1.1 to 1.8 times more likely than pessimists to use mechanical ventilation and 1.1 to 1.6 times more likely to use inotropic support to strengthen cardiac contraction for infants between 23 and 27 weeks of gestation.

• Optimists were twice as likely as pessimists to use thermal support and 1.2 times more likely to use oxygen.

• Optimists were 1.24 to 1.35 times more likely to use cardiopulmonary resuscitation and 1.24 to 1.5 times more likely to use intravenous fluids at 24 and 25 weeks gestation.

• Optimists were 1.2 to 1.3 times more likely to administer steroids to the mother and transfer the mother in preterm labor to a tertiary care facility with neonatal intensive care services.

[See: Morse SB, Haywood JL, Goldenberg RL, et al. Estimation of neonatal outcome and perinatal therapy use. Pediatrics 2000; 105:1,046-1,050.]

Drug reduces apnea in premature babies

A study conducted in nine U.S. neonatal intensive care units to evaluate caffeine citrate in the treatment of premature infants with apnea of prematurity revealed that the treatment is both safe and effective in reducing apnea attacks.

The study concluded that caffeine citrate was significantly better than placebo in reducing apnea of prematurity episodes in infants between 28 and 32 weeks post-conception. Caffeine citrate treatment, which was studied for a maximum of 12 days, significantly eliminated apnea of prematurity events on day two of treatment.

The multicenter study was a 10- to 12-day randomized, double-blind placebo-controlled trial with an open-label rescue phase. Preterm infants 28 to 32 weeks post-conception age who had six or more apnea episodes within 24 hours were eligible. A total of 85 infants were randomly assigned to two groups, with 46 receiving caffeine citrate and 39 receiving placebo. Findings include:

• On day two of treatment, 26.7% of caffeine citrate group babies had zero apnea events, compared with 8.1% of babies in the control group.

• The mean number of days without apnea events was 3.0 in the caffeine citrate group and 1.2 in the placebo group.

• The mean number of days with a 50% reduction from baseline in apnea events was 6.8 in the caffeine citrate group and 4.6 in the placebo group.

• Adverse events were similar between the caffeine citrate group and the placebo group. Six cases of necrotizing enterocolitis developed in the 85 infants studied. Five of the six were randomized to the caffeine citrate treatment group.

"This is the first time a placebo-controlled study of caffeine citrate has been conducted for the treatment of apnea of prematurity," reports Allen Erenberg, MD, study medical director, professor of pediatrics, and head of the section of neonatology and developmental biology at the University of Arizona's Health Sciences Center in Tuscon. "This study has shown that CAFCIT [caffeine citrate] is significantly more effective than placebo in reducing the number of apneic episodes by at least 50%, as well as eliminating apnea in more than 25% of treated infants."

Researchers note that caffeine citrate has been used to treat apnea of prematurity since the 1970s. However, hospital pharmacies were required to compound the caffeine citrate solution, which resulted in some incorrectly prepared formulations. Some of those mixtures resulted in overdoses, which were responsible for most reported adverse events associated with caffeine citrate.

Two dosage forms of CAFCIT have received approval from the Food and Drug Administration in Rockville, MD, to treat apnea of prematurity in infants between 28 and 33 weeks gestation. In late 1999, CAFCIT Injection was approved. Earlier this year, CAFCIT Oral Solution was approved; it can be used in both the hospital and home settings. CAFCIT is distributed by Roxane Laboratories in Columbus, OH.

Full prescribing information is available in PDF form at