Prolonged Caffeine Therapy for Preterm Infants

Approximately 13 million newborns were preterm (born before 37 weeks of gestation) across all member states of the World Health Organization in 2020. In 2023, the US preterm birth rate was 10.4%. Nearly all preterm infants require specialized in-hospital care to support their immature respiratory, cardiovascular, central nervous, digestive, and immune function. The length of the initial hospital stay depends on the duration of gestation, the medical condition at birth, and the development of complications such as infections or chronic lung disease. The main determinant of discharge readiness is the infant’s physiological maturity, defined as adequate control of breathing, respiratory stability, full oral feeding with appropriate weight gain, and good temperature control in a crib. In addition, the preparedness of the family and the suitability of the home environment should be confirmed. Most very preterm infants (those born between 28 and <32 weeks of gestation) are discharged home during the month preceding their original due date of delivery. However, discharge practices vary greatly, even when the characteristics of the preterm population and the health care systems are similar. Such variability reflects—at least in part—unavoidable uncertainty surrounding the optimal timing of discharge: For each individual patient, a balance has to be struck between maintaining the hospital stay as long as medically necessary but as short as possible to decrease family separation, parental stress, and costs.