Journal article
Extended Caffeine for Apnea in Moderately Preterm Infants: The MoCHA Randomized Clinical Trial
JAMA : the journal of the American Medical Association, Vol.333(24), pp.2154-2163
06/24/2025
DOI: 10.1001/jama.2025.5791
PMCID: PMC12038711
PMID: 40294395
Abstract
Hospitalization of moderately preterm infants may be prolonged while waiting for apnea of prematurity to resolve after discontinuing caffeine.
To evaluate whether extending caffeine treatment reduces the duration of hospitalization.
From February 2019 to December 2022, this randomized clinical trial in 29 US hospitals enrolled infants born at 29 to 33 weeks' gestation who at 33 to 35 weeks' postmenstrual age were receiving caffeine treatment with plans to discontinue it plus receiving full feeds (≥120 mL/kg/d). Follow-up was completed on March 20, 2023.
Infants were randomized to oral caffeine citrate (10 mg/kg/d) or placebo until 28 days after discharge.
The primary outcome was days to discharge after randomization. Secondary outcomes included days to physiological maturity (apnea free for 5 consecutive days, receiving full oral feeds, and out of the incubator for at least 48 hours), postmenstrual age at discharge, all-cause hospital readmissions, all-cause sick and emergency department visits, safety outcomes, and death.
A total of 827 infants (median gestational age, 31 weeks; 414 female [51%]) were randomized (416, caffeine; 411, placebo) out of the 878 planned before reaching the prespecified futility threshold. Days of hospitalization after randomization did not differ between groups (18.0 days [IQR, 10 to 30 days] for caffeine vs 16.5 [IQR, 10 to 27 days] for placebo; adjusted median difference, 0 days [95% CI, -1.7 to 1.7 days]), nor did days to physiological maturity differ (14.0 vs 15.0 days, adjusted median difference, -1 day [95% CI, -2.4 to 0.4 days]). Infants receiving caffeine were apnea free sooner (6.0 vs 10.0 days; adjusted median difference, -2.7 days [95% CI, -3.4 to -2.0 days ]) but had similar days to full oral feeding (7.5 vs 6.0 days, adjusted median difference, 0 days [95% CI, -0.1 to 0.1]). Rates of readmissions and sick visits did not differ between groups. There was no statistically significant difference in adverse events between the 2 groups.
In moderately preterm infants, continuation of caffeine treatment compared with placebo did not shorten hospitalization.
ClinicalTrials.gov Identifier: NCT03340727.
Details
- Title: Subtitle
- Extended Caffeine for Apnea in Moderately Preterm Infants: The MoCHA Randomized Clinical Trial
- Creators
- Waldemar A Carlo - University of Alabama at BirminghamEric C Eichenwald - Hospital of the University of PennsylvaniaBenjamin A Carper - RTI InternationalEdward F Bell - University of IowaMartin Keszler - Brown UniversityRavi M Patel - Emory UniversityPablo J Sánchez - The Ohio State UniversityRonald N Goldberg - Duke University HospitalCarl T D'Angio - University of RochesterKrisa P Van Meurs - Stanford UniversityAnna Maria Hibbs - Case Western Reserve UniversityNamasivayam Ambalavanan - University of Alabama at BirminghamShirley S Cosby - University of Alabama at BirminghamNancy S Newman - Case Western Reserve UniversityBetty R Vohr - Brown UniversityMichele C Walsh - Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentAbhik Das - RTI InternationalRobin K Ohls - University of UtahJanell Fuller - University of New MexicoSarvin Ghavam - Virtua Voorhees HospitalMatthew A Rysavy - Memorial HermannLuc P Brion - William P. Clements Jr. University HospitalKaren M Puopolo - Hospital of the University of PennsylvaniaRyan Moore - East Carolina UniversityMichelle L Baack - Sanford HealthTarah T Colaizy - University of IowaMariana Baserga - University of UtahAhmed F Osman - The Ohio State UniversityStephanie L Merhar - University of CincinnatiBrenda B Poindexter - Cincinnati Children's Hospital Medical CenterSara B DeMauro - Hospital of the University of PennsylvaniaVasanth Kumar - University at Buffalo, State University of New YorkC Michael Cotten - Duke University HospitalEunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
- Resource Type
- Journal article
- Publication Details
- JAMA : the journal of the American Medical Association, Vol.333(24), pp.2154-2163
- DOI
- 10.1001/jama.2025.5791
- PMID
- 40294395
- PMCID
- PMC12038711
- NLM abbreviation
- JAMA
- ISSN
- 0098-7484
- eISSN
- 1538-3598
- Publisher
- AMER MEDICAL ASSOC
- Grant note
- National Institutes of Health: U10 HD27871, U10 HD53119, UG1 HD21364, UG1 HD21373, UG1 HD21385, UG1 HD27851, UG1 HD27853, UG1 HD27856, UG1 HD27880, UG1 HD27904, UG1 HD34216, UG1 HD36790, UG1 HD40492, UG1 HD40689, UG1 HD53089, UG1 HD53109, UG1 HD68244, UG1 HD68270, UG1 HD68278, UG1 HD68263, UG1 HD68284, UG1 HD87226, UG1 HD87229 Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)National Center for Advancing Translational Sciences (NCATS): UL1 TR6, UL1 TR41, UL1 TR42, UL1 TR77, UL1 TR93, UL1 TR442, UL1 TR454, UL1 TR1117
This study was supported by grants U10 HD27871, U10 HD53119, UG1 HD21364, UG1 HD21373, UG1 HD21385, UG1 HD27851, UG1 HD27853, UG1 HD27856, UG1 HD27880,UG1 HD27904, UG1 HD34216, UG1 HD36790, UG1 HD40492, UG1 HD40689, UG1 HD53089, UG1 HD53109, UG1 HD68244, UG1 HD68270, UG1 HD68278, UG1 HD68263, UG1 HD68284, UG1 HD87226, UG1 HD87229 from the National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and UL1 TR6, UL1 TR41, UL1 TR42, UL1 TR77, UL1 TR93, UL1 TR442, UL1 TR454, UL1 TR1117 from the National Center for Advancing Translational Sciences (NCATS), which provided grant support through cooperative agreements for the Neonatal Research Network (NRN). NICHD staff provided input into the study design, conduct, analysis, and manuscript drafting; National Center for Research Resources (NCRR) and National Center for Advancing Translational Sciences (NCATS) cooperative agreements provided infrastructure support to the NRN.
- Language
- English
- Electronic publication date
- 04/28/2025
- Date published
- 06/24/2025
- Academic Unit
- Stead Family Department of Pediatrics; Neonatology
- Record Identifier
- 9984815917402771
Metrics
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