Acute caffeine overdose in the neonate

Area of Science:

• Neonatal Medicine
• Clinical Toxicology

Background:

• Parenteral administration of caffeine and benzoate sodium is used for respiratory depression in neonates.
• Clinical data on acute caffeine poisoning in neonates are limited.

Observation:

• Three full-term infants developed CNS irritability, including tachypnea, tremors, opisthotonus, and seizures, after receiving high-dose caffeine (36-136 mg/kg).
• Symptoms mimicked neonatal seizures, leading to anticonvulsant therapy.
• A premature infant with high plasma caffeine levels had altered symptoms due to intraventricular hemorrhage.

Findings:

• High-dose parenteral caffeine can induce significant CNS toxicity in neonates.
• Caffeine overdose symptoms in neonates can be mistaken for seizures.
• Concurrent conditions like perinatal asphyxia may exacerbate caffeine's proconvulsant effects.

Implications:

• Clinical recognition of caffeine toxicity is vital for appropriate neonatal care.
• Further research is needed to establish safe caffeine dosing protocols for newborns.
• This study highlights the potential risks of excessive caffeine administration in neonatal intensive care.