Summary of findings 4. High‐dose compared to standard‐dose strategies for the prevention of re‐intubation for preterm infants with or at risk for apnea of prematurity.
| High‐dose compared to standard‐dose strategies for the prevention of re‐intubation for preterm infants with or at risk for apnea of prematurity | ||||||
| Patient or population: preterm infants with or at risk for apnea of prematurity Setting: neonatal intensive care units Intervention: high‐dose strategies Comparison: standard‐dose strategies | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with standard‐dose strategies | Risk with high‐dose strategies | |||||
| All‐cause mortality prior to hospital discharge | Study population | RR 0.75
(0.25 to 2.30) RD ‐0.01 (‐0.07 to 0.04) |
238 (1 RCT) | ⊕⊝⊝⊝ Very lowa,b | We are uncertain whether high‐dose caffeine reduces all‐cause mortality prior to hospital discharge compared with standard‐dose caffeine. | |
| 57 per 1000 | 43 per 1000 (14 to 132) | |||||
| Major neurodevelopmental disability in children aged 18 to 24 months CA | See comments | ‐ | ‐ | ‐ | ‐ | This outcome was not reported. |
| Major neurodevelopmental disability in children aged 3 to 5 years CA | See comments | ‐ | ‐ | ‐ | ‐ | This outcome was not reported. |
| Mortality or major neurodevelopmental disability in children aged 18 to 24 months and 3 to 5 years CA | See comments | ‐ | ‐ | ‐ | ‐ | This outcome was not reported. |
| Bronchopulmonary dysplasia/chronic lung disease (BPD) at 36 weeks' postmenstrual age | Study population | RR 0.68
(0.48 to 0.97) RD ‐0.13 (‐0.25 to ‐0.01) NNTB = 8 |
238 (1 RCT) | ⊕⊕⊝⊝ Lowa,c | High‐dose caffeine might reduce slightly bronchopulmonary dysplasia at 36 weeks' postmenstrual age compared with standard‐dose caffeine. | |
| 418 per 1000 | 284 per 1000 (201 to 405) | |||||
| Side effects (tachycardia, agitation, or feed intolerance) leading to a reduction in dose or withholding of caffeine | See comments | ‐ | ‐ | ‐ | ‐ | This outcome was not reported. |
| Duration of hospital stay (days) | See comments | ‐ | ‐ | ‐ | ‐ | This outcome was not reported. |
| Seizures (clinically diagnosed; diagnosed by electroencephalography) | See comments | ‐ | ‐ | ‐ | ‐ | This outcome was not reported. |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CA: corrected age; CI: confidence interval; NNTB: number need to benefit; RD: risk difference; RR: risk ratio; | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
aDowngraded for study limitations by one level: unclear risk of bias in three domains (selection, detection, and reporting bias). bDowngraded for imprecision by two levels: few events and very wide confidence intervals. cDowngraded for imprecision by one level: few events.