To Caffeinate or Not to Caffeinate? The Dilemma in Neonatal Apnea Management

Caffeine, a widely used central nervous system stimulant, has emerged as the most commonly used therapeutic agent for managing apnea of prematurity in neonates over the last decade. Despite the evidence favoring caffeine, there are several controversies with the use of caffeine in neonates. Several studies have shown that caffeine significantly decreases cerebral blood flow velocity, impacting cerebral oxygenation and tissue oxygenation index. Higher doses of caffeine have raised safety concerns, with reports of increased incidence of cerebellar hemorrhage and adverse neurological outcomes in preterm infants. The duration of caffeine therapy remains a conundrum, with no consensus guidelines available. Neonatal units differ in their approaches to discontinuing caffeine therapy and discharging babies based on apnea-free intervals. The documentation and monitoring protocols for apnea vary across units, raising concerns about the accuracy of clinical recommendations. This article aims to unfold the complexities surrounding caffeine therapy in neonatal care, highlighting the potential concerns of using caffeine, especially in higher doses, while acknowledging the existing benefits for managing apnea of prematurity. We call on medical professionals to conduct more thorough research and controlled trials to understand better how to use caffeine effectively for premature babies for improving neonatal outcomes.