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A 10-week-old infant, born at 30 weeks’ gestation, was admitted from the emergency department with respiratory deterioration, proven subsequently as respiratory syncytial virus (RSV) bronchiolitis. Despite applying continuous positive airway pressure (CPAP) on the high dependency unit (HDU), there were frequent apnoeic episodes. You wonder as a paediatric registrar if caffeine has a role in treating bronchiolitis-related apnoea and can prevent further escalation to invasive ventilation.
Structured clinical question
In infants presenting with bronchiolitis-related apnoea (patient), does caffeine citrate (intervention) reduce the need for invasive ventilation (outcome)?
Primary sources: PubMed using keywords ‘bronchiolitis OR viral bronchiolitis’ AND ‘apnea OR apnoea’ AND ‘caffeine OR caffeine citrate OR xanthine OR methylxanthine’ resulted in 297 articles, 5 relevant. Further Medline and Embase searched gained an extra 24 with 12 potentially relevant.
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