Caffeine Use in the Management of Preterm Infants

Inclusion Criteria: • Infants born at equal to or less than 32 weeks and 0 days gestational age AND * Equal to or greater than 34 weeks and 0 days corrected gestation at time of enrollment. * Off respiratory support for at least 2 days (nasal canula oxygen, high flow nasal canula, continuous positive airway pressure (CPAP), mechanical ventilation). * On caffeine and meet criteria to discontinue caffeine. * No significant cardiopulmonary events for at least 5 days (apnea \> 20 seconds, apnea with heart rate (HR) \< 80 beats per minute (bpm), HR \< 80 bpm with desaturation \< 85% or color change). Exclusion Criteria: * Infants with critical congenital heart disease. * Infants with neuromuscular conditions affecting respiration. * Infants with overt brain injury (i.e. severe Grade 3-4 intraventricular hemorrhage, cystic periventricular leukomalacia) that may affect oral feeding. * Infants with major genetic disorders. * Infants with anatomic anomalies that will hinder oral feeding. * Infants who have already progressed to Step 3 (of 5) of our institution's oral feeding protocol (oral feeds 4 times per day). * Infants who develop necrotizing enterocolitis after enrollment. * Failure to obtain consent or declined by parents.