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ORIGINAL RESEARCH article

Front. Pediatr.

Sec. Neonatology

Volume 13 - 2025 | doi: 10.3389/fped.2025.1492716

Caffeine Use in Preterm Neonates: National Insights into Turkish NICU Practices

Provisionally accepted
Sezin Unal Sezin Unal 1Serdar Beken Serdar Beken 2*Deniz Anuk Ince Deniz Anuk Ince 1Ozden Turan Ozden Turan 1Ayse Korkmaz Ayse Korkmaz 2Ayse Ecevit Ayse Ecevit 1ABDULLAH BARIS AKCAN ABDULLAH BARIS AKCAN 3Mustafa Ali Akın Mustafa Ali Akın 4Selma Aktaş Selma Aktaş 2Nükhet Aladağ Çiftdemir Nükhet Aladağ Çiftdemir 5Emel Altuncu Emel Altuncu 6Huseyin Altunhan Huseyin Altunhan 7Baran Cengiz Arcagök Baran Cengiz Arcagök 2Didem Armangil Didem Armangil 8Esra Özer Esra Özer 9Banu Aydın Banu Aydın 10Handan Bezirganoglu Handan Bezirganoglu 11Leyla Bilgin Leyla Bilgin 12Erhan Calısıcı Erhan Calısıcı 13Şebnem Çalkavur Şebnem Çalkavur 14Kıymet Celik Kıymet Celik 15Yalcin Celik Yalcin Celik 16Bilin Cetinkaya Bilin Cetinkaya 1Merih Cetinkaya Merih Cetinkaya 17Atalay Demirel Atalay Demirel 2Gamze Demirel Gamze Demirel 18Nazan Neslihan Dogan Nazan Neslihan Dogan 19Pelin Doğan Pelin Doğan 2Mehtap Durukan Mehtap Durukan 20Defne Engür Defne Engür 21Tugba Erener Ercan Tugba Erener Ercan 22Zeynel Gokmen Zeynel Gokmen 1Ipek Guney Varal Ipek Guney Varal 23Selvi Gulasi Selvi Gulasi 24Ayla Gunlemez Ayla Gunlemez 25Tugba Gursoy Tugba Gursoy 18Handan Hakyemez Toptan Handan Hakyemez Toptan 26Serif Hamitoğlu Serif Hamitoğlu 27Fatih Isleyen Fatih Isleyen 28Irem Iyigun Irem Iyigun 29Sebnem Kader Sebnem Kader 30Dilek Kahvecioğlu Dilek Kahvecioğlu 31Gozdem Kaykı Gozdem Kaykı 32Murat Kostu Murat Kostu 33Dilek Kurnaz Dilek Kurnaz 34Tural Mammadalıyev Tural Mammadalıyev 35Ilke MUNGAN AKIN Ilke MUNGAN AKIN 36Nejat Narlı Nejat Narlı 37Emel Okulu Emel Okulu 38Nilufer OKUR Nilufer OKUR 39Ozgur Olukman Ozgur Olukman 27Fahri Ovalı Fahri Ovalı 40Beyza Ozcan Beyza Ozcan 41Ahmet Ozdemir Ahmet Ozdemir 42Ozmert Ozdemir Ozmert Ozdemir 43Hilal Özkan Hilal Özkan 44Gonca Sandal Gonca Sandal 45Dilek Sarici Dilek Sarici 46Cansu Sivrikaya Yildirim Cansu Sivrikaya Yildirim 47Betül SİYAH BİLGİN Betül SİYAH BİLGİN 48Saime Sundus Uygun Saime Sundus Uygun 49Ozge Surmeli Onay Ozge Surmeli Onay 50Huseyin Simsek Huseyin Simsek 51Ayse Tandırcıoğlu Ayse Tandırcıoğlu 52Sema Tanriverdi Sema Tanriverdi 53Kadir Şerafettin Tekgündüz Kadir Şerafettin Tekgündüz 54Demet Terek Demet Terek 55Gaffari Tunc Gaffari Tunc 56Turan Tunc Turan Tunc 57Ercan Tutak Ercan Tutak 58Eda Tufekcioğlu Eda Tufekcioğlu 59Funda Tuzun Funda Tuzun 60Ersin Ulu Ersin Ulu 61Dilek Ulubas Isik Dilek Ulubas Isik 62Nurdan Uras Nurdan Uras 63Sait Ilker Uslu Sait Ilker Uslu 64İrem Unal İrem Unal 65Fatma Hilal Yılmaz Fatma Hilal Yılmaz 66
  • 1 Başkent University, Ankara, Ankara, Türkiye
  • 2 Acıbadem University, Istanbul, Türkiye
  • 3 Adnan Menderes University, Aydın, Aydın, Türkiye
  • 4 Ondokuz Mayıs University, Samsun, Samsun, Türkiye
  • 5 Trakya University, Edirne, Edirne, Türkiye
  • 6 Istanbul Kartal Dr.Lutfi Kirdar Education and Research Hospital, Istanbul, Türkiye
  • 7 Meram Faculty of Medicine, Konya, Türkiye
  • 8 Koru Hospital, Ankara, Ankara, Türkiye
  • 9 Faculty of Medicine, Tınaztepe University, Izmir, Türkiye
  • 10 Lokman Hekim University, Ankara, Ankara, Türkiye
  • 11 Trabzon Legal Training and Research Hospital, Trabzon, Trabzon, Türkiye
  • 12 Istanbul University, Istanbul, Türkiye
  • 13 Gulhane Faculty of Medicine, University of Health Sciences (Turkey), Ankara, Ankara, Türkiye
  • 14 Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, İzmir, İzmir, Türkiye
  • 15 Akdeniz University, Antalya, Antalya, Türkiye
  • 16 Mersin University, Mersin, Mersin, Türkiye
  • 17 Basaksehir Cam and Sakura City Hospital, Istanbul, Türkiye
  • 18 Koç University, Istanbul, Istanbul, Türkiye
  • 19 Bakırköy Sadi Konuk Training and Research Hospital, Istanbul, Türkiye
  • 20 Mardin Training and Research Hospital, Mardin, Mardin, Türkiye
  • 21 Izmir Tepecik Training and Research Hospital, Izmir, Türkiye
  • 22 Maltepe University, Istanbul, Türkiye
  • 23 Bursa Yuksek Ihtisas Egitim Ve Arastirma Hastanesi, Bursa, Bursa, Türkiye
  • 24 Adana City Training and Research Hospital, Ministry of Health (Turkey), Adana, Adana, Türkiye
  • 25 Kocaeli University, İzmit, Kocaeli, Türkiye
  • 26 School of Medicine, Marmara University, Maltepe, Istanbul, Türkiye
  • 27 Izmir Bakircay University, Izmir, Türkiye
  • 28 Şanlıurfa Training and Research Hospital, Urfa, Türkiye
  • 29 Ordu University, Ordu, Ordu, Türkiye
  • 30 Kırklareli University, Kırklareli, Kırklareli, Türkiye
  • 31 Ankara Training and Research Hospital, Ankara, Ankara, Türkiye
  • 32 Faculty of Medicine, Hacettepe University, Ankara, Ankara, Türkiye
  • 33 İstanbul Kanuni Sultan Süleyman Eğitim ve Araştırma Hastanesi, Istanbul, Türkiye
  • 34 Haseki Training and Research Hospital, Istanbul, Türkiye
  • 35 Gazi University, Ankara, Ankara, Türkiye
  • 36 Umraniye Research and Training Hospital, University of Health Sciences, Istanbul, Istanbul, Türkiye
  • 37 Çukurova University, Adana, Adana, Türkiye
  • 38 Ankara University, Ankara, Ankara, Türkiye
  • 39 Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Diyarbakır, Türkiye
  • 40 Istanbul Medeniyet University, Istanbul, Türkiye
  • 41 Konya City Hospital, Konya, Türkiye
  • 42 Kayseri Education and Research Hospital, Kayseri, Türkiye
  • 43 Faculty of Medicine, Pamukkale University, Denizli, Türkiye
  • 44 Faculty of Medicine, Bursa Uludağ University, Bursa, Bursa, Türkiye
  • 45 Medipol University Hospital, Bağcılar, Istanbul, Türkiye
  • 46 Ankara Atatürk Sanatorium Training and Research Hospital, Ankara, Ankara, Türkiye
  • 47 Hatay State Hospital, Hatay, Türkiye
  • 48 Ankara Bilkent City Hospital University, Ankara, Ankara, Türkiye
  • 49 School of Medicine, Selcuk University, Konya, Türkiye
  • 50 Eskişehir Osmangazi University, Eskişehir, Eskişehir, Türkiye
  • 51 Mersin City Hospital, Toroslar, Mersin, Türkiye
  • 52 Kırıkkale University, Kırıkkale, Kırıkkale, Türkiye
  • 53 Manisa Celal Bayar University, Manisa, Manisa, Türkiye
  • 54 Atatürk University, Erzurum, Erzurum, Türkiye
  • 55 Ege University, Bornova, İzmir, Türkiye
  • 56 Cumhuriyet University, Sivas, Sivas, Türkiye
  • 57 Memorial Ataşehir Hospital, Ataşehir, Istanbul, Türkiye
  • 58 Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Türkiye
  • 59 Ankara Etlik City Hospital, Ankara, Ankara, Türkiye
  • 60 Faculty of Medicine, Dokuz Eylül University, Izmir, Türkiye
  • 61 Faculty of Medicine, Istanbul University Cerrahpasa, Istanbul, Türkiye
  • 62 Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Ankara, Türkiye
  • 63 Medical school, Istinye University, Istanbul, Türkiye
  • 64 Demiroglu Bilim University, Istanbul, Türkiye
  • 65 İlhan Varank Sancaktepe Training and Research Hospital, İstanbul, Türkiye
  • 66 Dr. Ali Kemal Belviranlı Maternity and Children Hospital, Konya, Türkiye

The final, formatted version of the article will be published soon.

    Objective: Caffeine is a proven medication used for the prevention and treatment of apnea in premature infants, offering both short- and long-term benefits. International guidelines provide a range of recommendations regarding the preterm population eligible for caffeine prophylaxis, including the timing, dosage, and duration of treatment. Our national guidelines, published prior to the most recent updates of the international guidelines, recommend the use of caffeine citrate starting from the first day after delivery for preterm infants with a gestational age of <28 weeks. For infants up to 32 weeks, if positive pressure ventilation is required, the decision should be made on an individual basis. This study aims to describe the variability in caffeine usage across neonatal intensive care units in our country.Methods: An online survey was sent to neonatologist who are members of the Turkish Neonatology Society to describe the variability in caffeine usage in neonatal intensive care units in our country. Results: We collected responses from 74 units. Prophylactic caffeine usage was observed as; GA < 276/7: 98.6%, GA 280/7-286/7: 89.0%, GA 290/7-296/7: 75.3%, GA 300/7-316/7: 53.4%. 62.2% of units reported administering loading dose within the first two hours. The initial maintenance dose was 5 mg/kg in 64.8% of units, 10 mg/kg in 32.4% of units, and intermediate dose in 5.3% of units. 47.3% of units reported no routine dose adjustment. The postmenstrual age that caffeine treatment was stopped was found to be 34 (min-max; 32-36) weeks for infants without apnea and respiratory support, 36 (min-max; 34-52) weeks for infants without apnea but any respiratory support. The time to discharge after treatment cessation was found as; 1-4 days: 37.8%, 5-7 days: 68.9%. Among the 56 units with multiple responsible physicians, 32.1% reported intra-unit variations. Conclusion: The significant differences in caffeine usage characteristics between and within units highlight the need for clear recommendations provided by standardized guidelines.

    Keywords: Caffeine, Premature neonate, apnea of prematurity, neonatal intensive care unit, guideline

    Received: 07 Sep 2024; Accepted: 28 Jan 2025.

    Copyright: © 2025 Unal, Beken, Anuk Ince, Turan, Korkmaz, Ecevit, AKCAN, Akın, Aktaş, Aladağ Çiftdemir, Altuncu, Altunhan, Arcagök, Armangil, Özer, Aydın, Bezirganoglu, Bilgin, Calısıcı, Çalkavur, Celik, Celik, Cetinkaya, Cetinkaya, Demirel, Demirel, Dogan, Doğan, Durukan, Engür, Ercan, Gokmen, Guney Varal, Gulasi, Gunlemez, Gursoy, Toptan, Hamitoğlu, Isleyen, Iyigun, Kader, Kahvecioğlu, Kaykı, Kostu, Kurnaz, Mammadalıyev, MUNGAN AKIN, Narlı, Okulu, OKUR, Olukman, Ovalı, Ozcan, Ozdemir, Ozdemir, Özkan, Sandal, Sarici, Sivrikaya Yildirim, SİYAH BİLGİN, Uygun, Surmeli Onay, Simsek, Tandırcıoğlu, Tanriverdi, Tekgündüz, Terek, Tunc, Tunc, Tutak, Tufekcioğlu, Tuzun, Ulu, Ulubas Isik, Uras, Uslu, Unal and Hilal Yılmaz. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Serdar Beken, Acıbadem University, Istanbul, Türkiye

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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