West Penn Hospital Study: Longer caffeine dosing benefits premature babies

Caffeine is an important weapon for neonatologists working to help premature infants with breathing problems. Now a study published online in JAMA Pediatrics, led in part by Nilima Karamchandani, MD, Medical Director of West Penn Hospital’s Neonatal Intensive Care Unit (NICU), found that a longer-than-usual course of treatment with caffeine can also help these tiny infants avoid hypoxia, low levels of oxygen in the body.

The study found that extending caffeine treatment, which normally stops at 34 weeks gestation, to 35 and 36 weeks gestation, reduced the number of hypoxia episodes by up to 50 percent.

“We know that intermittent hypoxia occurs frequently in premature infants after we cease routine caffeine treatment,” Dr. Karamchandani said. “This study provides valuable information on how we can continue using caffeine to prevent hypoxia as the baby grows.”

“The study also confirmed that extended use of caffeine is safe for premature infants,” Dr. Karamchandani said. “Only one infant required re-hospitalization during the course of the study, and that infant was part of the study’s control group.”

The researchers followed 95 preterm infants treated with caffeine through 34 weeks gestation and assigned about half to continued caffeine dosing through the 35th and 36th week, and half to a control group. Their blood oxygen levels were monitored through non-invasive continuous pulse oximeter readings.

Infants treated with caffeine had 50 percent fewer incidents of hypoxia than the control group. Caffeine’s benefit did not extend past 36 weeks, however. The reason for that is unknown, Dr. Karamchandani said, but may be that a higher dose is needed as the baby grows.

Because the lungs are among the last organs to develop in utero, breathing problems are very common among premature infants, those born before 40 weeks gestation. Infants born early are at high risk of neurological disabilities and developmental delays.

Apnea, in which the infant stops breathing during sleep for up to 20 seconds, is a very common problem associated with neurodevelopmental impairment. Several trials have demonstrated caffeine’s effectiveness in preventing apnea .

Hypoxia happens when the infant’s breathing problems prevent sufficient oxygen from reaching all parts of the body. These episodes put the infant at greater risk of damage to the eyes, ears or brain. Incidents of hypoxia tend to progressively increase over the first four weeks after birth, then reach a plateau and decline at six to eight weeks.

“This study documents for the first time that intermittent hypoxia is very common, even though the infant may show no clinical symptoms,” Dr. Karamchandani said. “Intermittent hypoxia’s adverse effect on children’s and adult’s cognitive performance is well-documented.”

The study is now available online and is published in the March issue of JAMA Pediatrics.

About the Allegheny Health Network:

Allegheny Health Network is an integrated healthcare delivery system serving the Western Pennsylvania region.  The Network is comprised of eight hospitals, including its flagship academic medical center Allegheny General Hospital, Allegheny Valley Hospital, Canonsburg Hospital, Forbes Hospital, Jefferson Hospital, Saint Vincent Hospital, Westfield Memorial Hospital and West Penn Hospital; the Allegheny-Singer Research Institute; a soon-to open medical mall; and a healthcare group purchasing organization.  

The Network employs approximately 17,000 people, including more than 2,100 physicians on its medical staff. The Network also serves as a clinical campus for both Temple University School of Medicine and Drexel University College of Medicine.