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Caffeine therapy offers preemies protection

Neonatal intensive care units often use caffeine therapy to help premature babies to breathe. But fears remain the therapy might help the lungs but hurt the brains of these fragile infants. Now a new report from on ongoing study looks at whether there was any impact on two-year-olds who underwent caffeine therapy at birth.


Newly published data suggest that giving premature infants caffeine therapy does not increase their risk of suffering from neurological problems, and in fact might protect against the development of cerebral palsy and cognitive delays.

The Canadian-led study is the strongest proof to date that the treatment - long used to help preemies breathe - does not lead to unwanted neurodevelopmental problems such as increased risk of blindness or deafness.

"I think it is very exciting for clinicians, and I think also for parents," lead author Barbara Schmidt said of the study, published today in the New England Journal of Medicine.

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"Because we now know that not only do we make the breathing a bit more regular, but we don't need to worry about any downstream adverse effects that outweigh these short-term benefits."

The study reports on neurological follow-up at 18 to 21 monthsof children who received the treatment in the days after their premature births. The researchers plan to continue testing the children for neurological problems until age 5.

"It's very assuring because the outcomes [at 18 to 21 months]are fairly predictive of the longer-term outcomes," said J.V. Aranda, who was not involved in this study but was one of the pioneers of caffeine therapy for preemies.

"They would tend to do well in their later years," he said from Detroit, where he is chief of clinical pharmacology and toxicology at Children's Hospital of Michigan.

Dr. Aranda first reported on the potential of using caffeine in premature babies with apnea while at McGill University in Montreal in the 1970s. Apnea is an irregular breathing pattern that can result from being born pre-term.

Dr. Schmidt began her research while serving as a professor of pediatrics and clinical epidemiology at McMaster University in Hamilton, Ont. She has since taken an appointment with the University of Pennsylvania and practises at the Children's Hospital of Philadelphia.

The researchers are following 1,869 premature infants born around the world, testing whether the widespread practice of treating preemies suffering from apnea with caffeine improved survival rates and had an impact on the rates of neurological problems experienced by these health-challenged infants.

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In May, 2006, the researcher reported in the New England Journal of Medicine that the treatment was effective in improving breathing. But long-term follow-up was needed to answer concerns that giving newborn babies caffeine wouldn't be solving one problem by creating another.

This latest study suggests lingering fears that caffeine could hurt the brains or nervous systems of these children are probably unfounded.

The babies who were randomly selected to be given caffeine therapy had lower rates of cerebral palsy - 4.4 per cent in the caffeine group compared with 7.3 per cent in the children who received a placebo. And there were fewer children with cognitive delays in the caffeine group - 33.8 per cent compared with 38.3 per cent in the placebo group.

Dr. Aranda expected the trial would show caffeine didn't raise the risk of these conditions, but he was pleasantly surprised to see it might actually reduce risks. "Not only is it safe, it's probably beneficial," he said.

The authors suggested that for every 16 preemies who receive caffeine therapy, one case of death or neurodevelopmental disability is avoided.

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