Preemies may benefit from caffeine jolt

A mega-jolt of caffeine may be just what the doctor should order to help premature babiesget through their potentially dangerous first days, a Canadian-led study confirms.

Doctors have used caffeine and similar drugs to regulate the breathing of preterm infants for more than 25 years, but they've lacked evidence to back up the practice.

"It is a very common treatment and it is one for which we just did not have enough safety data and even efficacy data beyond the first few days of life," said study author Dr. Barbara Schmidt, a professor of pediatrics atMcMaster University in Hamilton, Ont.

About 85 per cent of preemies are prone to apnea, an interruption of their breathing that can deprive the brain of oxygen.

To explore the risks and benefits of caffeine therapy, Schmidt and her colleagues launched an international study of more than 2,000 preemies, many of them Canadian, during the first 10 days of life.

About half were assigned to caffeine therapy, the rest got a placebo.

Fewer babies who got caffeine, 36 per cent, needed extra oxygen, compared to 47 per cent in the placebo group, the team reports in Thursday's issue of the New England Journal of Medicine.

Breathing wake-up call

Put another way, caffeine therapy resulted in an average of seven fewer days on ventilation. They also ended up with less scarring on their lungs.

In the short term, caffeine showed no harmful effects on the infants. Those who received caffeine tended to gain weight more slowly, but they caught up once the therapy was discontinued.

Seven-week-old M.J. Prato is one baby receiving caffeine treatment. She weighs about 1.5 kilograms and is receiving the caffeine equivalent of what in adults would be six cups of coffeeat a time.

"First we asked questions," said her mother, Tricia Prato, of Toronto. "Now that we understand why, it makes perfect sense."

It's thought caffeine may "wake up" the brain's breathing centre, making it fire more regularly.

Animal studies show caffeine can affect the developing brain, and the researchers caution they don't know if there are any long-term effects of caffeine therapy.

They plan to follow the babies until age five to check.

The study doesn't address if caffeine helps the smallest infants who stay on mechanical ventilationlonger, or those given caffeine at a later age, once lung damage has occurred, Dr. Eduardo Bancalari, a pediatrician at the University of Miami, noted in a journal commentary.