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Abstract SUMMARY AND CONCLUSION ecrotizing enterocolitis is one of the worst medical problems occurring in neonates. It is more common in premature babies, with mortality rate more than 50% in very low birth weight. The etiology of NEC is multifactorial, and the most important risk factors are prematurity, hypoxia and/or intestinal ischemia. Many medications have been implicated as a risk factor in NEC such as Xanthine derivatives, such as theophylline, aminophylline and caffeine. Caffeine is now one of the most commonly prescribed drugs in the NICU, and has appropriately been described as a ”silver bullet” in neonatology. When the Food and Drug Administration approved caffeine citrate (Cafcit) for the treatment of apnoea of prematurity, a warning was included in the label about the possible association between the use of methylxanthines and the development of necrotizing enterocolitis. Pulsed Doppler US is used to measure blood-flow velocity in the superior mesenteric artery for investigating the maturation of intestinal circulation and the pathogenesis or pathophysiology of gastrointestinal diseases in newborn infants and we used it to evaluate the effect of caffeine citrate on the SMA BFV. N Summary and Conclusion 137 Our study included 38 preterm, less than 34 weeks with no significant PDA, major congenital anomalies or perinatal asphyxia. They were all subjected to the following: 1. Full history taking 2. Thorough clinical examination including 3. Recorded APGAR score at 1st&5th minutes 4. CBC&CRP 5. Abdominal Doppler ultrasound - Superior mesenteric artery peak systolic and end diastolic velocities measured using Doppler ultrasound.blood pressure & heart rate - The first measurements were taken 15 min before caffeine loading dose administration. - These measurements repeated at 60, 120 and 360 min after caffeine loading dose administration, and were taken 120 min after the caffeine maintenance dose administration for 2 successive days. 6. All infants were examined for signs of necrotizing enterocolitis for at least 72 h after completion of SMA BFV measurement. Twenty two preterm completed the study whereas, two (5.2%) of the studied neonates developed NEC within three Summary and Conclusion 138 days following the loading dose of the caffeine citrate, four (10.5%) were transmitted to a different NICU, six (15%) died before completing the full caffeine citrate regimen and four were excluded from the study due to their unstable general condition. We found that caffeine citrate had variable hemodynamic effects of the SMA that were different at each time of measurement. By 2 hours of giving LD of caffeine citrate there was significant decrease in PSV and EDV with significant increase of RI in comparison to these measures before the loading dose of each baby. At 6 hours, these measures were nearly normalized in relation to the pre loading measures. All the previous measures, after starting maintenance dose, did not show any significant difference in relation to the pre loading measures. After discontinuation there was non significant increase in PSV, EDV and RI in comparison to the pre loading measures. We found no significant change in mean BP (But there was mild increase) except after discontinuation of caffeine when there was a significant increase in relation to pre loading period. Summary and Conclusion 139 We also, did not find any significant variation in HR of our babies (but there was a mild increase) all over the study. There were only 2 babies that developed NEC of within the first 3 days following the loading dose. As a conclusion. Our data show that the loading dose of caffeine citrate to preterm neonates causes a prolonged and significant reduction in SMA BFV for 1-2 hours which had returned to baseline within 6 hours. Whether this observation is of clinical importance is unclear, but it is a finding of which clinicians should be aware and one which deserves further study. |