Caffeine for the prevention of acute kidney injury in neonates: a systematic review and meta-analysis.

This systematic review and meta-analysis evaluated whether caffeine administration within the first 7 days after birth reduces neonatal AKI without increasing adverse events. Randomized and nonrandomized studies were identified through MEDLINE, CENTRAL, and EMBASE. Risk of bias was assessed using RoB2 and ROBINS-I, and the certainty of evidence was rated using GRADE. Twenty-five studies were included, six of which reported AKI outcomes. Three adjusted observational studies were eligible for meta-analysis. Early caffeine administration resulted in a large reduction in AKI (915 participants; aOR 0.16; 95% CI 0.09-0.31; low-certainty evidence). The evidence was very uncertain about early caffeine administration reducing maximum serum creatinine levels (one study; 50 participants; MD -0.42 mg/dL; 95% CI -0.58 to -0.26; very low-certainty evidence). No increase in adverse events was observed, although the pooled estimates of adverse events were unavailable. Early caffeine administration is associated with reduced neonatal AKI without evidence of increased adverse events.