Caffeine impact on neonatal morbidities

Abstract

Caffeine is a silver bullet in neonatology. This ubiquitous trimethylxanthine, pervasively used in the human diet and beverages, significantly impacts on major acute neonatal morbidities including apnea of prematurity, bronchopulmonary dysplasia, patent ductus arteriousus with or without surgical ligation and post-operative apnea. Potential uses in respiratory distress syndrome as suggested by improved lung function in primate models is supported by the decreased time on mechanical ventilation and need for oxygen therapy. Improved later outcomes at 18 to 22 months include clinically significant decreases in cerebral palsy, cognitive impairment, and severe retinopathy of prematurity in those babies who received caffeine during the neonatal period compared to non-caffeine treated placebo neonates. Ongoing and future research studies focus on optimizing current dose regimens to determine whether benefits can be maximized while maintaining an impressive safety profile. Molecular pharmacologic studies focused on the molecular and the biochemical mechanisms underlying the protective effects of caffeine are also being done to optimize treatment regimes and to target potential molecular pathways leading to further decreases in acute and long term neonatal morbidities. Since its use in newborns three decades ago, caffeine is now one of the safest, most cost-beneficial and effective therapies in the newborn.

Neonatal Intermittent Hypoxia, Reactive Oxygen Species, and Oxygen-Induced Retinopathy

“…These drugs act through different mechanisms and synergistic approaches should be considered to target oxidative stress and ROS accumulation, as well as the inflammatory mechanisms associated with ROP. Caffeine citrate, which is used worldwide and is standard of care for AOP [143, 144] has been shown to have antioxidant properties [145], to significantly reduce the incidence of severe ROP [146], and to normalize aberrant retinal proteomic profiles in OIR [147]. Non-steroidal anti-inflammatory drugs (NSAIDs) have also been shown to reduce the incidence of ROP [148].…”

Recurrent Apnea Following Occipital Encephalocele Surgery in A Child -Responding to Caffeine Citrate

“…Caffeine has been the panacea in the management of apnea of prematurity (3). In addition, in preterm, caffeine has established benefits in facilitating extubation, shortening the duration of intubation and noninvasive respiratory support, reduction in the incidence of bronchopulmonary dysplasia, decreasing need for treatment of patent ductus arteriosus, improving neuro-developmental outcome and reducing the severity of retinopathy of prematurity.…”

“…Its citrate salt has been the drug of choice in the prevention and treatment of apnea in preterm newborns and has appropriately been described as a "silver bullet" in neonatology (3). Although, the exact mechanism of action of caffeine citrate is not known, several theories exist which have been attributed to mainly antagonism of adenosine receptors.…”

53: Is Caffeine a Risk Factor for Osteopenia of Prematurity?

“…It is one of the most commonly prescribed drugs in the NICU, and has appropriately been described as a "silver bullet" in neonatology to treat apnea of prematurity (Aranda ,Natarajan& Davis, 2010). Caffeine is a trimethylxanthine that primarily exerts its effects by increases levels of 3'5' cyclic AMP by inhibiting phosphodiesterase: a central stimulant which increases medullary respiratory center sensitivity to carbon dioxide, stimulates central inspiratory drive, and improves skeletal muscle contraction (diaphragmatic contractility).…”