Paediatric Acute care Guidelines PMH Emergency Department

Medication

  • CAUTION:  Caffeine Base 1mg = Caffeine Citrate 2mg
  • To minimise dosing errors, always prescribe as Caffeine Base or Caffeine Citrate
  • Caffeine Base is the preparation used at PMH

Actions

  • Stimulates central inspiratory drive
  • Increases sensitivity of the medullary centre to CO2

Indications

  • Used for prevention or treatment of apnoea of prematurity or apnoeas associated with respiratory infection or anaesthesia
  • To aid extubation of ventilated babies

Adverse

  • Nausea, vomiting and gastric irritation
  • Agitation
  • Tachycardia
  • Diuresis
  • Overdose – arrhythmias, seizures

Dosage

Loading Dose:

  • 20mg/kg (Caffeine base)
  • Administer undiluted via syringe pump over 30 minutes
  • May be diluted with 0.9% Saline or 5% Dextrose to make a convenient volume for infusion if required
  • May be infused via peripheral IV or orally

Maintenance Dose:

  • 5 – 7.5mg/kg/day (Caffeine base)
  • Commence maintenance dose at least 24 hours after loading dose
  • Administer via syringe pump over 10 minutes
  • Maybe diluted with 0.9% Saline or 5% Dextrose to make a convenient volume for infusion if required
  • May be infused by peripheral IV or given orally

 

Preparation

  • Oral Solution:  10mg / mL  (Oral dose to be given with feeds)
  • Ampoule for IV Use:  50mg / 5mL (Caffeine base)

Special

  • Routine monitoring of drug level is not required
  • Check levels if toxicity is suspected or to check therapeutic range
  • Therapeutic range: 5 – 30 mg/L
  • Toxic range:  >50 mg/L
  • Sampling time:  midway between doses
  • Observe infants for symptoms of toxicity:
    • tachycardia
    • jitteriness
    • tremors
    • unexplained seizures
    • vomiting

References

PMH ED Guidelines:  Caffeine Administration – Last Updated September 2014
NCCU Clinical Guidelines, KEMH/PMH, Caffeine
AMH Children’s Dosing Companion (online). Adelaide: Australian Medicines Handbook Pty Ltd; 2014 July. Available from: https://childrens.amh.net.au
Paediatric Dosage Handbook International 17th Edition (2011)
EMIMS 2012
Australian Injectable Drugs Handbook 5th Edition (2011)

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