Caffeine for Apnea of Prematurity (CAP)

Summary

At least 5 of every 1000 live-born babies are very premature and weigh only 500 to 1250 grams at birth. Approximately 30-40% of these high-risk infants either die or survive with lasting disabilities. The aim of this research is to reduce this heavy burden of illness. A multi-center randomized controlled trial has been designed in which 2000 very low birth weight infants will be enrolled. Our goal is to determine whether the avoidance of methylxanthine drugs will improve survival without disability to 18 months, corrected for prematurity.

Methylxanthine drugs such as caffeine are used to prevent or treat periodic breathing and breath-holding spells in premature infants. However, there is a striking lack of evidence for the long-term efficacy and safety of this therapy. Methylxanthines block a naturally occurring substance, called adenosine, which protects the brain during episodes of oxygen deficiency. Such episodes are common in infants who are treated with methylxanthines. It is possible that methylxanthines may worsen the damage caused by lack of oxygen. Therefore, this trial will clarify whether methylxanthines cause more good than harm in very low birth weight infants.

Conditions

• Apnea of Prematurity

Interventions

DRUG

Caffeine citrate injection

Loading dose: 20 mg/kg administered over at least 30 minutes via IV infusion or over at least 10 minutes via slow IV injection. Daily maintenance dose (to commence at least 24 hours after loading dose): 5 mg/kg, administered over at least 10 minutes via IV infusion, or over at least 5 minutes via slow IV injection. Maintenance dose to be adjusted for body weight every 7 days. If indicated, maintenance dose may be increased to a maximum of 10 mg/kg. May be given orally once full enteral feeds are established. Duration of treatment: discontinue after infant has tolerated at least 5 consecutive days without positive pressure support AND when the infant is judged by the attending clinician to be no longer a candidate for methylxanthine therapy.

Sponsors & Collaborators

• Canadian Institutes of Health Research (CIHR)

  collaborator OTHER_GOV

• National Health and Medical Research Council, Australia

  collaborator OTHER

• McMaster University

  lead OTHER

Principal Investigators

• Barbara K Schmidt, MD · McMaster University

• Robin S Roberts, MTech · McMaster University

• Peter Davis, MD · Royal Women's Hospital, Melbourne, Australia

• Lex Doyle, MD · Royal Women's Hospital, Melbourne, Australia

• Arne Ohlsson, MD · Mount Sinai Hospital, Canada

• Alfonso Solimano, MD · Children & Women's Health Centre of BC, Vancouver, Canada

• Win Tin, MD · James Cook University Hospital, Middlesbrough, UK

• Keith J Barrington, MD · Royal Victoria Hospital/McGill University, Montreal, Canada

• Elizabeth Asztalos, MD · Sunnybrook Health Sciences Centre, Toronto, Canada

• Deborah Dewey, MD · University of Calgary, Alberta, Canada

• Ruth Grunau, MD · University of British Columbia, Vancouver, Canada

• Diane Moddemann, MD · University of Manitoba, Winnipeg, Canada

• Peter Anderson, PhD · University of Melbourne, Australia

Study Design

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

TRIPLE

Model

PARALLEL

Eligibility

Max Age

10 Days

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

1999-10-31

Primary Completion

2007-03-31

Completion

2016-07-31

Countries

• United States
• Australia
• Canada
• Germany
• Israel
• Netherlands
• Sweden
• Switzerland
• United Kingdom

Study Locations