Early caffeine benefits premature babies: study

Earlier use of caffeine is associated with improved outcomes for extremely premature infants. A Canada-wide study led by the University of Calgary has observed that infants who received early caffeine spent less time on mechanical ventilators and had less risk of chronic illnesses related to lungs later in life.

The study, which was headed by Dr. Abhay Lodha and conducted in partnership with Alberta Health Services, was published Nov. 17 in The Journal of the American Medical Association (JAMA) Pediatrics. It was released on World Prematurity Day, which is held on that date each year to raise awareness about premature births and the problems faced by such babies and their families.

“An important aspect of this study is the reassurance that no adverse effects were observed with early caffeine,” says Lodha, an assistant professor in the Department of Paediatrics at the Cumming School of Medicine and a member of the university’s Alberta Children’s Hospital Research Institute. “This data is in contrast to potential adverse effects that were reported by other studies.”

Lodha’s team of researchers found no evidence caffeine causes harm when administered in a hospital during the first two days after the birth of extremely premature infants, potentially increasing its benefits into later childhood — particularly cutting the risk of chronic lung disease. Concern about earlier use has meant caffeine to stimulate breathing often begins on the third day, when respiration problems usually start to appear, he says.

Caffeine given intravenously or orally is the most common therapy to prevent apnea (cessation of breathing) in premature infants. Elevating the metabolism through processes such as stimulation of cardiac muscle, as well as possibly boosting sensitivity to things such as carbon dioxide, helps prevent apnea associated with immature lungs or respiratory distress syndrome, says Lodha. It can also reduce the need for ventilator machines, minimizing immediate complications to organs ranging from the lungs to the heart, as well as improving survival later in life without impaired neurological development.

The study was undertaken on behalf of the Canadian Neonatal Network and included researchers from the University of Manitoba, Dalhousie University, Université de Montreal and University of Toronto. The team looked at 5,517 infants, who were born at less than 31 weeks gestation at 29 neonatal intensive care units across Canada between 2010 and 2012, says Lodha. “A major strength of this study is the large sample of infants.”

Birth normally occurs at about 40 weeks. The earlier babies are born, especially before 32 weeks of gestation, the more challenges they face, says Lodha, adding those born before 24 weeks gestation face a high likelihood of dying. “The respiratory centers in their brains are quite immature, so they forget to breathe,” he says. “Their lungs are also immature and lacking a substance called surfactant, so they have to be put on a ventilator machine at a high pressure for a long time.”

This can cause damage to immature lungs, resulting in subsequent lung scarring and creating a chronic condition called bronchopulmonary dysplasia (BPD), he says. The condition affects up to 60 per cent of premature infants, who often require oxygen therapy (oxygen given through nasal prongs, a mask, or a breathing tube) for more than 28 days of life. Most of the premature infants who develop chronic lung disease or BPD are born more than 10 weeks before their due dates, weigh less than 1,000 grams at birth and have some breathing problems.

Early caffeine use is also associated with less risk of ductus arteriosus, a small blood vessel in the hearts of developing infants that normally closes in full-term babies after birth, but can remain open in those born prematurely. Because it carries less oxygen, it causes such babies to tend to stay longer on ventilators, increasing the risk of BPD.

Aileen Soare delivered a pre-term baby in 2013. Jonah was born at 24 weeks and weighed only 605 grams. As a mom, Aileen knows what a terrifying ordeal it is to be in hospital and have a sick child. “When you become a parent of an extremely premature baby, you face so many risks and fears of the unknown,” she says.

“You don’t know if he will have long-term health issues, disabilities and developmental delays, or even if he will survive his first year of life. We feel so blessed and lucky that Jonah was able to overcome so many health obstacles in the NICU (Neonatal Intensive Care Unit) and left the hospital without requiring any additional oxygen support. With the help of the amazing team of doctors, nurse practitioners, nurses, respiratory therapists and staff at the NICU, Jonah is now a healthy, active toddler with a great future ahead of him.”

The study was funded by the federal Canadian Institutes of Health Research (CIHR) and the Ontario Ministry of Health and Long-Term Care.