Remarks

• The GDG noted that evidence was available only for preterm infants born before 34 weeks’ gestation, but suggests that caffeine (or other methylxanthines) may also be considered for extubation of preterm infants born at or after 34 weeks and before 37 weeks, depending on clinical judgement.
• The GDG noted that there were limited data on the timing of initiation and duration of administration. Based on the largest trials (169,175) included in the evidence review, the GDG suggested starting caffeine 24 hours before a planned extubation. If the extubation is unplanned, the infant should receive the caffeine as soon as possible after the extubation and within 6 hours, and should continue to receive it for six days.
• The GDG noted that there were limited data on the dosage. Based on the largest trials (169,175) included in the evidence review, the GDG suggested a 20 mg/kg loading dose and 5 mg/kg per day maintenance dose for six days.
• If caffeine is not available, other methylxanthines (aminophylline or theophylline) may be considered.