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Efficacy and Safety of Caffeine for Apnea of Prematurity

Caffeine is safe and significantly reduces neurodevelopmental disability in very-low-birth-weight infants.

Caffeine is often administered for apnea of prematurity (AOP), despite a lack of safety data. In a multisite, double-blind, randomized trial, 2006 infants with birth weights between 500 and 1250 grams received either caffeine citrate (supplied by the manufacturer) or saline placebo until the AOP resolved.

At a corrected age of 18 to 21 months, infants in the treatment group were significantly more likely to survive without neurodevelopmental disability (cerebral palsy, blindness, severe hearing loss, cognitive delay) than were infants in the placebo group (59.8% vs. 53.8%). Caffeine significantly reduced the incidence of cerebral palsy (4.4% vs. 7.3%, respectively) and cognitive delay (33.8% vs. 38.3%, respectively). Earlier discontinuation of positive airway pressure and use of supplemental oxygen explained most of the beneficial effect of caffeine.

Comment: Not only does caffeine seem to be safe (Journal Watch Pediatrics and Adolescent Medicine Jun 6 2007), but it also seems to significantly reduce disability when used for treatment of AOP in very-low-birth-weight infants. An editorialist notes that caffeine works primarily by improving ventilation.

— Howard Bauchner, MD

Published in Journal Watch Pediatrics and Adolescent Medicine November 7, 2007

Citation(s):

Schmidt B et al. Long-term effects of caffeine therapy for apnea of prematurity. N Engl J Med 2007 Nov 8; 357:1893.

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• Medline abstract (Free)

Stevenson DK. On the caffeination of prematurity. N Engl J Med 2007 Nov 8; 357:1967.

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• Medline abstract (Free)