Caffeine addiction: optimising neonatal caffeine use

Caffeine is the most widely used stimulant in humans and has become ubiquitous in neonatal intensive care following the key Caffeine for Apnoea of Prematurity (CAP) trial. 1 In this study, Schmidt et al. randomized 2006 very low birth weight (VLBW) infants to receive either caffeine or placebo until treatment for apnoea was no longer required. 1There were significant improvements in motor outcomes at 2 years and fine motor development at 5 years, including enhanced visuomotor, visuoperceptual, and visuospatial functions with reduced developmental coordination disorder 1-3 and benefits persisting through 11 years of age. 4 In 2010, the Cochrane review by Henderson-Smart and De Paoli found significant decreases in apnoeic episodes with caffeine administration, reducing the need for mechanical ventilation and improving outcomes. 5Similarly, metanalysis by Alhersh et al suggested that although mortality was not reduced, there was a significant decrease in the need for mechanical ventilation. 6A recent comprehensive meta-analysis by Oliphant et al. confirmed caffeine's effectiveness in reducing apnoea and preventing neurodevelopmental impairment. 7affeine is a methylxanthine and exerts pleiotropic effects, including immunomodulatory actions and antagonism of adenosine receptors, which play a key role in suppressing respiratory drive.The increased oxygen consumption associated with methylxanthines, including caffeine, may have significant impacts on multiorgan growth and function in preterm infants. [8][9][10][11][12] In their recent study published in this journal, Ostrem et al. 13 investigated the relationship between cumulative caffeine exposure and neurodevelopmental outcomes.Among the primary cohort of 67 preterm infants, higher caffeine doses were associated with improved motor, language, and cognitive performance on the Bayley-III assessment.These findings remained significant after adjusting for gestational age and respiratory disease.However, these associations were not observed in the larger cohort of 106 infants, suggesting that while higher maintenance dosing may confer neurodevelopmental benefits, the evidence remains inconclusive, necessitating further investigation to establish optimal dosing strategies.