Caffeine citrate 200mg/5ml oral solution

BACKGROUND: Caffeine is widely used for the treatment of neonatal apnea, but there is no agreement on the optimum maintenance dose for preterm infants. OBJECTIVE: The aims of this meta-analysis were to compare the efficacy and safety of high versus low maintenance doses of caffeine citrate for the treatment of apnea in premature infants. METHODS: Literature searches were conducted using PubMed, Cochrane Library, OVID, Embase, Web of Science, Chinese Biomedical Literature, Weipu Journal, Wanfang, and CNKI databases up to September 2018. Only randomized controlled trials (RCTs) of caffeine citrate for apnea treatment in premature infants were included. Trials were divided into those testing high maintenance doses (10-20 mg/kg daily) and low maintenance doses (5-10 mg/kg daily) for comparison. Data collection and extraction, quality assessment, and data analyses were performed according to the Cochrane standards. RESULTS: Among the 345 studies initially identified, thirteen RCTs involving 1515 patients were included. Compared to the low-dose group, the high-dose group exhibited greater effective treatment rate (RR: 1.37, 95%CI: 1.18 to 1.60, P0.05). CONCLUSIONS: Higher maintenance doses of caffeine citrate appear more effective and safer than low maintenance doses for treatment of premature apnea, despite a higher incidence of tachycardia.

Abstract licence: CC BY 4.0

Background and aimsCaffeine citrate is an example of a methylxanthine approved for managing apnea of prematurity (AOP). However, there is limited evidence of its use in low- and middle-income countries (LMICs). This rapid systematic review aims to appraise the literature on using caffeine citrate in managing neonatal apnea in LMICs.MethodsA comprehensive search was conducted on literature reporting the treatment of AOP in LMICs. The search was based on a population, intervention, comparison, and outcome format using medical subject heading terms. The PRISMA and PRISMA extension for scoping reviews guidelines were meticulously followed. PubMed, Science Direct, and Scopus were among the bibliographic databases searched. Initially, 2638 articles were identified based on the keywords used. However, after eliminating duplicates and implementing advanced options (only full-text, language, and year), the articles were further screened by abstract and title, ensuring a rigorous selection process.ResultsThe evaluation of 10 studies involving 1010 preterm infants provided compelling evidence. Our findings demonstrated that caffeine citrate, compared to aminophylline, had fewer adverse effects. The adverse effects, including feeding intolerance, tachycardia, central nervous system derailment, and hyperglycemia, were significantly reduced with caffeine citrate. Furthermore, data from the included studies revealed that caffeine citrate had a lower risk of recurrent apnea and was less likely to fall out of the recommended therapeutic range than aminophylline. These results unequivocally establish caffeine citrate's safety, efficacy, and cost-effectiveness in treating prematurity apnea in LMICs, providing a reliable and beneficial intervention for neonatal care in these regions.ConclusionCaffeine may be a preferred option in managing AOP in LMICs. However, high drug prices and lack of availability of caffeine may be factors limiting its use in these settings.

Abstract licence: CC BY-NC 4.0

Background: Apnea of prematurity affects at least 85% of infants born before 34 weeks' gestation and represents a significant clinical challenge in neonatal intensive care. Methylxanthines, including caffeine, theophylline, and aminophylline, have emerged as the primary pharmacological intervention for this condition. Objective: To conduct a comprehensive systematic review of the use of methylxanthine in the treatment and prevention of apnea episodes in preterm infants, evaluating efficacy, safety, and long-term outcomes. Methods: We searched multiple databases including PubMed, Embase, Web of Science for randomized controlled trials, retrospective studies, or case-control studies of methylxanthine effects in preterm apnea. Risk of bias was assessed using the Cochrane Risk of Bias tool. Results were summarized narratively and grouped by methylxanthine type, study design, and primary outcomes (reduction in frequency and severity of apnea episodes, success of extubation, risk of bronchopulmonary dysplasia). Results: Twenty-five studies (n = 4599 preterm infants) were included. The landmark Caffeine for Apnea of Prematurity (CAP) trial (n = 2006) demonstrated that caffeine therapy significantly reduced bronchopulmonary dysplasia (36.3% vs. 46.9%, adjusted OR 0.63) and facilitated the earlier discontinuation of positive airway pressure (median 1 week earlier). Studies with a smaller number of cases have consistently demonstrated the efficacy of methylxanthines in reducing the incidence of bronchopulmonary dysplasia and apneic episodes and in supporting successful extubation. Long-term follow-up at 11 years showed improved pulmonary function (FEV1 z-score -1.00 vs. -1.53). Discussion: Limitations of this review include heterogeneity in outcome definitions, small sample sizes in early studies, and the dominance of evidence from the CAP trial. Methylxanthines, particularly caffeine, are an evidence-based intervention used for apnea of prematurity, with demonstrated benefits that extend beyond reducing the frequency and severity of apnea episodes, including decreasing the risk of bronchopulmonary dysplasia as well as reducing the need for mechanical ventilation. No external funding was received for this review. No registration record exists for this systematic review.

Abstract licence: CC BY

BackgroundCaffeine citrate is recommended to treat apnea of prematurity in premature neonates based on high-quality evidence demonstrating improved outcomes. In contrast, the prescription of caffeine for mature neonates and infants hospitalized with apnea is based on a paucity of evidence. We present here our protocol for a systematic review to synthesize existing data on the safety and effectiveness of caffeine treatment for apnea in hospitalized pediatric patients, with findings expected to focus on mature neonates and infants.MethodsWe developed this systematic review protocol in accordance with the PRISMA guidelines and PRISMA-P checklist. The search strategy was developed with the assistance of an information specialist. Information sources will include MEDLINE, Embase, CINAHL, and CENTRAL databases, as well as unpublished literature sources. Eligible studies will include randomized controlled trials, non-randomized trials, and observational studies investigating caffeine (of any formulation, administered by any route, of any duration) versus placebo, usual care, or non-methylxanthine comparator. The population of interest is children aged 0-17 years with apnea presenting to emergency, critical care, or in-patient settings; studies of premature babies receiving treatment for apnea of prematurity will be excluded. Critical outcomes include total duration of respiratory support, ventilator-free days, duration of invasive mechanical ventilation, duration of non-invasive respiratory support, time to apnea cessation, and serious adverse events. Two authors will independently screen identified studies against prespecified eligibility criteria. Data from included studies will be abstracted in duplicate and entered into our data abstraction form. Risk of bias for each included study will be independently assessed by two reviewers using the appropriate risk of bias tool. If appropriate, we will perform a meta-analysis. The quality of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, with results presented in a summary of findings table.DiscussionWe will undertake the first rigorous evidence synthesis examining the safety and efficacy of caffeine treatment for apnea in hospitalized pediatric patients, where studies of premature babies with apnea of prematurity will be specifically excluded. We aim to fill the identified knowledge gap with this systematic review.Systematic review registrationPROSPERO CRD420251146484.

Abstract licence: CC BY

BackgroundWrestling is a popular combat sport that requires muscular strength, power, agility, and endurance. Weight classes have motivated wrestlers to compete at a lower weight to optimise power-to-weight ratio and performance. To achieve these characteristics, athletes may use dietary supplements, however, their efficacy in wrestlers has not been systematically evaluated.ObjectiveThe purpose was to systematically review the literature to determine the efficacy of dietary supplements to improve body composition, physiological status, and performance in wrestlers.MethodsA systematic search was conducted in PubMed, ProQuest Medline, Web of Science, Cochrane Library, and Scopus on the 21st of January 2024 and updated on the 6th of January 2025. Studies were included if the participants were healthy wrestlers ingesting any type of dietary supplement in comparison to a control. Data associated with intervention type and characteristics, target populations, outcomes, and analysis methods were extracted.ResultsA total of 24 eligible original articles were included that assessed various supplementation strategies on body composition, exercise performance, and metabolic markers in wrestlers. Individual studies revealed significant effects of sodium citrate, creatine monohydrate, spirulina, green tea and oolong tea extracts, and branched-chain amino acids on body mass or composition. β-Hydroxy-β-methylbutyrate (HMB-FA), creatine monohydrate, and iron supplementation improved recovery and may improve exercise performance. Beet-root juice supplementation enhanced muscular strength and balance. BCAA supplementation produced mixed results on muscle damage biomarkers and performance, while sodium citrate, creatine, and spirulina can act as buffering agents. Thyme tea appears to improve antioxidant capacity.ConclusionsOverall, individual studies show some promise for several dietary supplements to alter body mass and body composition, improve exercise recovery and performance, delay fatigue, and modify serum biomarkers; nevertheless, effect sizes were often small, and results were often mixed.

Abstract licence: CC BY

BACKGROUND: Methylxanthine, including caffeine citrate and aminophylline, is the most common pharmacologic treatment for apnea of prematurity. However, due to the lack of high-quality evidence, there are no clear recommendations or guidelines on how to choose between caffeine and aminophylline. OBJECTIVE: This meta-analysis aimed to assess the comparative efficacy and safety of caffeine and aminophylline for apnea of prematurity, and provide reliable evidence for clinical medication in the treatment for apnea of prematurity. METHODS: PubMed, Scopus, Embase, EBSCO, Web of Science, and Cochrane databases were systematically searched from May 1975 to June 2022. RESULTS: Ten studies including a total of 923 preterm infants were evaluated. Our results showed that there was no significant difference in the effective rate of 1-3days between caffeine and aminophylline (OR 1.05, 95%CI: 0.40-2.74, P = 0.914). However, for side effects such as tachycardia (OR 0.22, 95%CI: 0.13-0.37, P<0.001) and feeding intolerance (OR 0.40, 95%CI: 0.23-0.70, P = 0.001), the incidence rate was lower in the caffeine group compared with the aminophylline group. No significant difference was found in hyperglycemia (OR 0.45, 95%CI: 0.19-1.05, P = 0.064). CONCLUSION: This meta-analysis reveals that caffeine citrate and aminophylline have similar therapeutic effectiveness on respiratory function, but caffeine has fewer side effects and should be considered first for treatment.

Abstract licence: CC BY 4.0