Beyond apnea: Early caffeine therapy and the risk of acute kidney injury in very low birth weight infants

Abstract

Introduction

Acute kidney injury is a frequent but often underrecognized complication in very low birth weight preterm infants. In addition to its established respiratory benefits, caffeine has been suggested to have potential renal-protective effects. The aim of this study was to evaluate the association between early caffeine administration and the incidence of acute kidney injury in preterm infants with a birth weight of 1250g or less.

Methods

This retrospective cohort study included 156 preterm infants with a gestational age of 30 weeks or less and a birth weight of 1250g or less. Infants were divided into two groups according to caffeine exposure. The caffeine group received prophylactic caffeine within the first 24 h of life, while the control group did not receive caffeine. Acute kidney injury was defined using serum creatinine measurements during the first 14 postnatal days.

Results

Acute kidney injury occurred in 10.3% of infants who received caffeine and in 28.2% of those who did not receive caffeine (p = 0.004). Early caffeine administration was independently associated with a significantly lower risk of acute kidney injury (adjusted odds ratio 0.29; 95% confidence interval 0.11–0.74). No infants in the caffeine group developed stage 2 or stage 3 acute kidney injury.

Conclusions

Early prophylactic caffeine administration is associated with a reduced incidence of acute kidney injury in very low birth weight preterm infants. These findings suggest a potential renal-protective role of caffeine in this vulnerable population. Prospective multicenter studies are needed to confirm these results and evaluate long-term safety.