Caffeine for apnea of prematurity: Effects on the developing brain

Area of Science:

• Neonatal Medicine
• Neuroscience
• Pharmacology

Background:

• Caffeine is a methylxanthine used to treat apnea of prematurity (AOP) in preterm infants.
• It reduces respiratory support duration, improves survival, and lowers rates of cerebral palsy and cognitive delay.
• Limited evidence exists on caffeine's immediate and long-term effects on cellular and molecular brain development.

Purpose of the Study:

• To review how caffeine ameliorates AOP.
• To examine the cellular and molecular mechanisms of caffeine's effects.
• To assess caffeine's impact on brain development in preterm infants.

Main Methods:

• Review of experimental and clinical studies on caffeine's effects in AOP.
• Analysis of cellular and molecular mechanisms.
• Evaluation of preclinical data on brain development.

Main Results:

• Caffeine provides respiratory benefits for preterm infants.
• Experimental data on caffeine's effects on the developing brain are conflicting, with a majority suggesting detrimental changes.
• Adverse molecular and cellular effects on the developing brain are possible, irrespective of dose or duration.

Conclusions:

• While beneficial for AOP, caffeine may have adverse effects on the developing preterm brain at molecular and cellular levels.
• Urgent preclinical studies are needed to assess caffeine's impact on brain structure and function across various doses.
• Future research should determine the maximal safe dose of caffeine for the preterm brain.