More Caffeine, Less Long-Term Damage for Premature Infants?

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By: Katie Millar, Technical Writer, Women and Health Initiative, Harvard T.H. Chan School of Public Health

Caffeine can help us start our day or get us through a drowsy afternoon. But did you know caffeine can also help prevent a premature baby from having apneic spells, or periods of not breathing? Since 1977 we have known that pharmacological caffeine given to premature infants can help stimulate their immature brains and lungs to breath—preventing life threatening damage due to hypoxia, or lack of oxygen. This caffeine is usually given until the baby reaches 34 weeks gestation, or the time when the brains and lungs should be mature enough to breathe on their own.

A recent study by Dr. Lawrence Rhein from Harvard Medical School and the Caffeine Pilot Study Group sought to evaluate if 34 weeks is really the best time to stop using caffeine. Dr. Rhein explained, “[34 weeks] is about that age that most babies stop having clinically obvious hypoxic spells. But the question has been, are there continued but less obvious episodes that we could and should be preventing? And can caffeine play a role in doing so?”

What did the study find? Give the babies more caffeine. There are real, but less obvious, hypoxic spells after 34 weeks and giving caffeine to premature infants until 40 weeks, or term, gestation helps prevent them. The six week extension on administering caffeine prevented the hypoxic spells—or blood oxygen saturation levels below 90 percent. When blood oxygen levels were measured, babies in the extended caffeine treatment group experienced 52 percent less hypoxic spells and 47 percent less time under 90 percent oxygen saturation.

Finding a healthy balance of oxygen levels for a premature infant is often a delicate science. While decreased oxygen can cause long term developmental morbidities and even death, supplemental oxygen and high oxygen saturation in the blood can also contribute to the development of retinopathy of prematurity (ROP), which may lead to blindness. The findings for this study provide at least a partial solution to this difficult balance by showing that caffeine can help stabilize oxygen saturation levels.

Moving forward more research is needed to evaluate the types and consequences of the less obvious hypoxic spells occurring after 34 weeks. “Our data showed that [hypoxic] episodes can continue for weeks after caffeine is discontinued,” Rhein said. “Those episodes were not clinically obvious, but we don’t yet know which episodes we need to react to. We’re setting the stage to ask whether some of the episodes that we don’t think are significant can affect long-term cognitive development.” The answers to these questions have implications for both the future of the premature infant and family.

If the hypoxic spells do affect long-term cognitive development, then treatment through extended caffeine has implications for improving outcomes and decreasing the need of special education services and health care costs to the family.

Adapted from two articles—one in Vector, Boston Children’s Hospital’s science and clinical innovation blog and the other in news from Harvard Medical School.

Do you have thoughts or insight on the effects of neonatal hypoxia? How your facility addresses neonatal hypoxia? Do you use caffeine? If not, why not? If you are interested in submitting a blog post on neonatal hypoxia, please email Katie Millar.