Caffeine administration

Disclaimer

These guidelines have been produced to guide clinical decision making for the medical, nursing and allied health staff of Perth Children’s Hospital. They are not strict protocols, and they do not replace the judgement of a senior clinician. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline. 

Read the full PCH Emergency Department disclaimer.

Aim

To guide staff in the use of caffeine administration.

Background 

Rarely a neonate presents to ED who is experiencing apnoea and it is determined after senior consultation that the baby will benefit from caffeine infusion.

This guideline has been developed to assist in safe administration of caffeine in the emergency setting.

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 PCH.

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

Bibliography

  1. KEMH Medication Protocol: Caffeine 
  2. AMH Children’s Dosing Companion (online). Adelaide: Australian Medicines Handbook Pty Ltd; 2014 July. Available from: https://childrens.amh.net.au
  3. Paediatric Dosage Handbook International 17th Edition (2011) EMIMS 2012.
  4. Australian Injectable Drugs Handbook 5th Edition (2011)


Endorsed by:  Director, Emergency Department  Date:  Feb 2018


 Review date:   Feb 2021


This document can be made available in alternative formats on request for a person with a disability.