Summary: A new study reveals caffeine therapy appears to have benefits for healthy brain development in children born prematurely. Researchers report preterm babies given caffeine therapy had better cognitive scores, reduced odds of cerebral palsy and less hearing impairments as toddlers.
Source: University of Calgary.
For many, starting the day off with caffeine from a cup of coffee is a must. In neonatal intensive care units, or NICUs, premature babies born under 29 weeks are given a daily dose of caffeine to ensure the best possible start to life. A new study by University of Calgary researchers shows the earlier the dose of caffeine can be given, the better.
“Caffeine is the most commonly used drug in the NICU after antibiotics,” says Dr. Abhay Lodha, MD, associate professor in the departments of Paediatrics and Community Health Sciences at the Cumming School of Medicine and staff neonatologist with Alberta Health Services (AHS). “It’s important that we understand the long-term effects of caffeine as a treatment and ensure these babies are not only surviving, but have quality of life down the road.”
Born prematurely at 27 weeks at the Foothills Medical Centre, Kyle and Avril Strachan’s baby, Anna, was given caffeine to help her breathe and boost lung function.
“The doctors told us, with premature babies, their brain hasn’t developed quite enough to let them do all the things their bodies should be doing on its own, like breathing,” says mom Avril. “In the first few weeks, when Anna was feeding, she would slow down or even forget to breathe. This would cause her heart to slow and for her to not get enough oxygen.”
To help her breathe more easily, Anna needed a continuous positive airway pressure, or CPAP, machine to deliver constant airflow to her lungs.
A 2014 study by Lodha showed starting caffeine therapy within two days after birth shortened the amount of time babies needed to use ventilators. It also reduced the risk of bronchopulmonary dysplasia (BPD), a form of chronic lung disease caused by damage to the lungs from use of a ventilator. What was not known was how that dose of caffeine affected brain development.
Lodha collaborated with researchers from the Universities of British Columbia, Montreal, Toronto and Mount Sinai Hospital in Toronto to analyze data from 26 NICUs across Canada. They found early caffeine treatment has no long-term negative effects on neurodevelopment, and is actually associated with better cognitive scores, and reduced odds of cerebral palsy and hearing impairment. The findings are published in Pediatrics.
The team examined data from follow-up assessments conducted at age 18 to 24 months. During these follow-ups, children were assessed for their cognitive, language and motor development using the Bayley Scales of Infant and Toddler Development, a standardized scoring system to assess developmental functioning in infants and toddlers.
“We look at how children are constructing their understanding, such as solving simple problems or figuring out three-dimensional objects and toys,” says Dr. Dianne Creighton, PhD, research assistant professor in the Department of Paediatrics and retired psychologist with AHS. “We also assess how the little ones are able to understand simple words, or recognize the name of a picture, as well as their motor skills like climbing, crawling, balance and co-ordination.”
Lodha says it’s believed that caffeine may increase the growth of dendrites, the small branches of a neuron that receive signals from other neurons. “Caffeine may also improve better lung stretch and expansion, cardiac output and blood pressure in premature infants, which improves oxygen supply throughout the body and brain, reducing the duration of mechanical ventilation and the risk of chronic lung disease and injury on the developing brain.”
Now two years old, Anna has completed multiple follow-up assessments and is participating in dance classes, gymnastics lessons and swimming like a fish, says her mom Avril.
“She’s very mechanical. She likes to build things, take it apart and figure out how it works,” she says. “It’s wonderful to know that the caffeine treatment has no adverse effects and that if researchers are getting positive findings, it should continue to be the standard of care for premature babies. In that case, I think parents would have no hesitation in having caffeine as part of their child’s treatment.”
Drs. Abhay Lodha and Dianne Creighton are associate members of the Alberta Children’s Hospital Research Institute.
Funding: This study was conducted with data from the Canadian Neonatal Network and the Canadian Neonatal Follow-up Network, which is supported by the Maternal-Infant Care Research Centre at Mount Sinai Hospital.
Source: Pauline Zulueta – University of Calgary
Publisher: Organized by NeuroscienceNews.com.
Image Source: NeuroscienceNews.com image is credited to Riley Brandt, University of Calgary.
Original Research: Abstract for “Early Caffeine Administration and Neurodevelopmental Outcomes in Preterm Infants” by Abhay Lodha, Rebecca Entz, Anne Synnes, Dianne Creighton, Kamran Yusuf, Anie Lapointe, Junmin Yang, Prakesh S. Shah, on behalf of the investigators of the Canadian Neonatal Network (CNN) and the Canadian Neonatal Follow-up Network (CNFUN) in Pediatrics. Published December 2018.
Early Caffeine Administration and Neurodevelopmental Outcomes in Preterm Infants
BACKGROUND: Although caffeine use for apnea of prematurity is well studied, the long-term safety and benefit of routine early caffeine administration has not been explored. Our objective was to determine the association between early (within 2 days of birth) versus late caffeine exposure and neurodevelopmental outcomes in preterm infants.
METHODS: Infants of <29 weeks’ gestation born between April 2009 and September 2011 and admitted to Canadian Neonatal Network units and then assessed at Canadian Neonatal Follow-up Network centers were studied. Neonates who received caffeine were divided into early- (received within 2 days of birth) and late-caffeine (received after 2 days of birth) groups. The primary outcome was significant neurodevelopmental impairment, defined as cerebral palsy, or a Bayley Scales of Infant and Toddler Development, Third Edition composite score of <70 on any component, hearing aid or cochlear implant, or bilateral visual impairment at 18 to 24 months’ corrected age.
RESULTS: Of 2108 neonates who were eligible, 1545 were in the early-caffeine group and 563 were in the late-caffeine group. Rates of bronchopulmonary dysplasia, patent ductus arteriosus, and severe neurologic injury were lower in the early-caffeine group than in the late-caffeine group. Significant neurodevelopmental impairment (adjusted odds ratio 0.68 [95% confidence interval 0.50–0.94]) and odds of Bayley Scales of Infant and Toddler Development, Third Edition cognitive scores of <85 (adjusted odds ratio 0.67 [95% confidence interval 0.47–0.95]) were lower in the early-caffeine group than in the late-caffeine group. Propensity score–based matched-pair analyses revealed lower odds of cerebral palsy and hearing impairment only.
CONCLUSIONS: Early caffeine therapy is associated with better neurodevelopmental outcomes compared with late caffeine therapy in preterm infants born at <29 weeks’ gestation.