With improved survival rates of preterm neonates, there is increase in number of infants with bronchopulmonary dysplasia (BPD). BPD is an important morbidity in very preterm neonates, with global pooled prevalence of 21 percent. Caffeine is a methylxanthine group of drugs. The role of Caffeine for preventing anemia of prematurity, and benefits related to long term neurodevelopmental outcomes are well-known. However, optimal timing of Caffeine initiation remains under investigation. By this study, we aim to fill this gap, and establish the benefits of early administration of Caffeine on respiratory outcomes in very preterm neonates. 

This study aims to compare early versus routine Caffeine administration in very preterm neonates (born at less than 32 weeks gestational age), and its effects on incidence of BPD. 

A prospective, randomized trial will be conducted at the department of Neonatology, AIIMS Nagpur, where eligible neonates will be randomized into intervention and control groups using block randomization. The intervention group will receive standard loading dose of Caffeine (20mg per kg) in the delivery room, within one hour of birth. The control group will receive the same loading dose after NICU admission (within 1 to 3 hours after birth). Respiratory parameters will be monitored. 

Babies will be monitored until 36 completed weeks of corrected gestational age or till hospital discharge, whichever is later. 

The primary objective is to compare the incidence of BPD in very and extremely preterm neonates receiving early versus routine Caffeine administration. Secondary objectives include short term respiratory outcomes, oxygen requirement, requirement of postnatal steroid administration, duration of NICU stay, and echocardiographic parameters of systemic blood flow.