Caffeine is routinely used in the management of apnea of prematurity. Extremely low birth
weight (ELBW) infants are at higher risk of mortality and various neonatal morbidities such
as bronchopulmonary dysplasia (BPD) for which caffeine has been shown to be beneficial in
very low birth weight (VLBW) infants. The investigators' previous unpublished retrospective
studies and recently published retrospective studies demonstrated that early caffeine given
within 48 hours of age tended to decrease the incidence of death and BPD in ELBW newborns.
Retrospective design can be biased as newborns with mild lung disease may have received
caffeine early for extubation. There are several studies on pharmacodynamics and
pharmacokinetics of caffeine. The data regarding cumulative dosage of caffeine, caffeine
levels and BPD outcome is deficient.
Primary objective of this study is to test the hypothesis that early caffeine given within 24
hours of life will decrease incidence of mortality and BPD in ventilated ELBW newborns.
This study will also test an additional hypothesis that higher caffeine dosage and caffeine
levels are associated with decreased mortality and postnatal morbidities in studied newborns.