Early Versus Conventional Discontinuation of Caffeine Therapy for Apnea of Prematurity: A Randomized Controlled Trial-The DECaf Trial.

OBJECTIVES

While caffeine therapy is well-established for managing apnea of prematurity (AOP), standardized protocols for its discontinuation are lacking. This study evaluated whether earlier cessation at 33 weeks postmenstrual age (PMA) is as safe as conventional discontinuation at 34 weeks.

METHODS

Preterm neonates (26-32 weeks of gestation) on caffeine for AOP, who were off respiratory support and apnea-free for 5 consecutive days by 33 weeks PMA, were randomized to early discontinuation (Group A) or conventional discontinuation at 34 weeks PMA (Group B). The primary outcome was recurrence of apnea (RAP) post-cessation.

RESULTS

Apnea recurrence was similar between groups (13.7% vs. 10%; OR 1.44, p = 0.71). Caffeine duration was significantly shorter in Group A (21.5 vs. 28.5 days, p = 0.024). No significant differences were noted in secondary outcomes or neonatal morbidities.

CONCLUSIONS

Early discontinuation of caffeine at 33 weeks PMA in stable preterm neonates appears safe and may reduce drug exposure without increasing apnea risk.