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Caffeine in Preterm Infants and its Effect on Neonatal Sleep: A Systematic Review

Kristina Denisova1, Nicholas Diamandis1, Jean Ee Tang2

  • 1Division of Math and Natural Sciences, Department of Psychology, Autism Origins Lab, City University of New York, Queens College and Graduate Center, New York, NY, USA.

Journal of Clinical Pharmacology
|September 29, 2025
PubMed

Insights

Caffeine administration in neonatal intensive care units may disrupt sleep and sensorimotor development in preterm infants during their first month of life. Further research is needed to clarify these effects.

Area of Science:

  • Neonatal Medicine
  • Developmental Pediatrics
  • Pharmacology

Background:

  • Preterm infants in neonatal intensive care units (NICUs) often experience poor sleep quality, impacting development.
  • Caffeine is commonly administered to preterm infants as a stimulant, but its effects on sleep are not fully understood.

Purpose of the Study:

  • To systematically review existing evidence on the sleep-disruptive effects of caffeine in preterm infants within the first month of life.
  • To assess caffeine's impact on sleep-wake states and sensorimotor functioning in this vulnerable population.

Main Methods:

  • A comprehensive literature search was conducted across major databases (PubMed, Embase, Scopus, PsycInfo, CENTRAL) following PRISMA guidelines.
  • Included studies focused on preterm infants (<37 weeks gestational age) receiving caffeine in the NICU, with sleep measures recorded within the first month.
  • Eight studies met the eligibility criteria, with results analyzed using albatross plots.

Main Results:

  • 83.33% of studies reported significant caffeine-induced disruptions in wakefulness among preterm infants.
  • 100% of studies indicated significant reductions in sensorimotor functioning.
  • Significant reductions in sleep states were also observed, suggesting potential alterations in sleep architecture.

Conclusions:

  • Available evidence suggests caffeine exposure may alter sleep-wake and sensorimotor functioning in preterm infants during the first month.
  • The overall evidence is mixed, with some studies showing no effect, highlighting the need for further investigation.
  • Understanding caffeine's precise impact on neonatal sleep quality is crucial for optimizing care in the NICU.

Keywords:
caffeinecentral nervous system stimulantsearly postnatal periodinfantneonatal intensive care unitsneonatal sleepneonatologyprematuresensorimotor functionsystematic reviewwakefulness

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