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Caffeine impairs cerebral and intestinal blood flow velocity in preterm infants
Christina Hoecker1, Mathias Nelle, Johannes Poeschl
1Department of Paediatrics, Division of Neonatology, University of Heidelberg, Heidelberg, Germany. christina_hoecker@med.uni-heidelberg.de
Insights
A high loading dose of caffeine significantly reduced cerebral and intestinal blood flow velocity in preterm infants. This effect occurred without altering left ventricular output, blood pressure, or heart rate.
Area of Science:
- Neonatal physiology
- Pharmacology
- Cardiovascular research
Background:
- Caffeine is widely used for apnea treatment in preterm infants.
- Adult studies suggest caffeine decreases cerebral blood flow.
- The impact of caffeine on infant circulatory parameters requires further investigation.
Purpose of the Study:
- To evaluate the effects of a high oral loading dose of caffeine on circulatory parameters in preterm neonates.
- To assess changes in cerebral and intestinal blood flow velocity following caffeine administration.
Main Methods:
- 16 preterm neonates (gestational age 31 ± 1.2 weeks) received an oral loading dose of 25 mg/kg caffeine.
- Doppler sonography was used to measure left ventricular output (LVO), cerebral blood flow velocity (BFV) in the internal carotid artery (ICA) and anterior cerebral artery.
- Intestinal BFV was assessed in the celiac artery and superior mesenteric artery before and 1-2 hours after caffeine administration.
Main Results:
- Caffeine significantly reduced mean BFV in the ICA (17-22%) and anterior cerebral artery (14%) at 1-2 hours post-dose.
- Intestinal BFV decreased significantly in the superior mesenteric artery (30%) and celiac artery (14%).
- No significant changes were observed in LVO, blood pressure, or heart rate.
Conclusions:
- A high loading dose of oral caffeine leads to a substantial reduction in cerebral and intestinal blood flow velocity in preterm infants.
- These circulatory changes occur independently of alterations in LVO, blood pressure, or heart rate.
- Findings highlight potential hemodynamic effects of caffeine loading doses in neonates.
Objective:
In adults, a single dose of 250 mg of caffeine may decrease cerebral blood flow by 30%. In preterm infants, caffeine is commonly used for the treatment and prophylaxis of apnea. The purpose of this investigation was to assess effects of caffeine on circulatory parameters in preterm infants.
Methods:
We studied 16 preterm neonates with a mean gestational age (mean +/- standard deviation) of 31 +/- 1.2 weeks (range: 29-33 weeks), birth weight of 1400 +/- 380 g (range: 625-2060 g), and postnatal age of 24 to 72 hours before and 1 and 2 hours after an oral loading dose of 25 mg/kg pure caffeine. We investigated left ventricular output (LVO), cerebral blood flow velocity (BFV) of the internal carotid artery (ICA) and the anterior cerebral artery, and intestinal BFV of the celiac artery and superior mesenteric artery by Doppler sonography.
Results:
Mean BFV in the ICA decreased significantly 1 (17%) and 2 hours (22%) after caffeine administration. Mean BFV in the anterior cerebral artery showed a reduction of 14% after 2 hours. The mean BFV in the superior mesenteric artery decreased significantly 1 and 2 hours after caffeine administration (30%). Mean BFV in the celiac artery showed a significant reduction of 14% 1 hour after caffeine. No changes were observed in LVO, blood pressure, and heart rate.
Conclusion:
Oral administration of a high loading dose of caffeine results in marked reduction of cerebral and intestinal BFV, without changing LVO, blood pressure, and heart rate.