Association of Caffeine Daily Dose With Respiratory Outcomes in Preterm Neonates: A Retrospective Cohort Study.

Apnea and poor respiratory drive increase the risk of extubation failure (EF) and prolonged invasive mechanical ventilation (IMV) in preterm neonates (pre-nates) with respiratory distress. Caffeine citrate (CC) is often prescribed for pre-nates in doses of 5-10 mg/kg in 24 h. This study aimed to evaluate the most effective dosage regimen (5 mg/kg/day vs >5-10 mg/kg/day) to prevent apnea and EF with minimal caffeine-associated potential side effects (CC-APSEs) in pre-nates. This one-year retrospective cohort study included all the eligible neonates admitted to NICU and received CC-therapy till 28 days of life (DOL) or discharge. Based on CC-daily dose formed LD-caffeine-group (5 mg/kg/day) and HD-caffeine-group (>5-10 mg/kg/day). Antenatal, prenatal, and postnatal characteristics, CC-regimen, comorbidities, and CC-APSEs were compared between the groups. Predictors of apnea and EF were analyzed through logistic regression. There were 181 and 72 neonates in the LD and HD-caffeine-groups respectively. In HD-caffeine-group daily CC-dose was 7 to 7.5 mg/kg/day in 93% of neonates and >7.5 to 10 mg/kg/day in only 7%. Significantly fewer neonates experienced apnea and EF in the HD-caffeine-group till 28DOL or discharge. This difference was even greater in the subgroup of ≤28 weeks GA (15.6% vs 40.0%; P < .01). In HD-caffeine-group the incidence of severe/moderate-BPD was significantly lower and the frequency of CC-APSEs was higher. Multivariate analysis showed that; the smaller the GA higher the risk of apnea (AOR = 0.510, 95% CI 0.483-0.999) and EF (AOR = 0.787, 95% CI 0.411-0.997). The HD-caffeine was inversely associated with developing apnea (AOR = 0.244, 95% CI 0.053-0.291) and EF (AOR = 0.103, 95% CI 0.098-2.976). IMV-duration before extubation (AOR = 2.229, 95% CI 1.672-2.498) and severe/moderate-BPD (AOR = 2.410, 95%CI 1.104-2.952) had a high risk of EF. Initiating early HD-caffeine may prevent apnea and extubation failure in preterm neonates. Optimization of caffeine initiation time and dosages can be a safe and feasible approach to decrease the burden of neonatal respiratory morbidities.

Pattern of Abuse in Children With Behavioral Disorders Presenting to a Tertiary Care Hospital in Peshawar.

Objective To determine the different types of child abuse and its association with behavioral disorders in children presenting to a tertiary care hospital. Materials and methods One hundred abused Pakistani children, of both genders, were included. Children with cerebral palsy, a neurodegenerative disorder, chronic illness, chronic liver disease, congenital heart disease, chronic renal failure, and parents who refused to become part of the study were excluded. Descriptive statistics were calculated. The chi-square test was applied to compare the pattern of abuse among various types of behavioral disorders. P≤0.05 was considered significant. Results The mean age of the study was 10.38±2.64 years. The total number of males was 51 (51%); the rest (49; 49%) were females. The most common behavioral disorder was functional disorder (n=59, 59%) followed by depression (n=26, 26%). The most frequent abuse was physical (n=87, 87%) followed by verbal (n=7, 7%) and the least was sexual (n=6, 6%). There was no statistically significant association between type of behavioral disorder and type of abuse in children (P=0.162). Conclusion The most common type of child abuse among children with behavioral disorders is physical abuse followed by verbal. The type of behavioral disorder is not associated with a specific type of child abuse.