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Bronchiolitis is a common respiratory illness in infants in winter months. Recurrent apnoeas in high risk infants with severe bronchiolitis increases the need for respiratory support (nasal continuous positive airway pressure and ventilation) and transfer to the paediatric intensive care unit (PICU).1 During the winter of 2003–04 we had three babies presenting with apnoeas secondary to bronchiolitis. All three babies were ex-preterm infants under 3 months of age. All had deterioration in their respiratory status potentially needing further care in PICU. On advice of two PICU consultants these babies were treated with a loading dose of caffeine. All three showed immediate improvement in their respiratory status and avoided being transferred out. Caffeine is a respiratory stimulant widely used in the treatment of apnoea of prematurity.2
Following our experience we performed a questionnaire survey of the use of caffeine for apnoeas in bronchiolitis across 20 intensive care units in the UK. We made a thorough literature search to look at the evidence.
Of the 20 questionnaires sent, only 10 replies were received. Opinion was divided between PICU consultants, with four stating that they would advice a trial of caffeine. This made a total of six, including the two who advised us previously. The evidence from literature is anecdotal.3
We conclude that there is little evidence in literature to support the use of caffeine in bronchiolitis, and there is divided opinion in PICUs across the UK. We feel that caffeine is a relatively simple treatment option in a district general hospital for apnoeas in bronchiolitis and recommend a randomised controlled trial. We would welcome comments on similar experiences from readers.
Competing interests: none declared