Caffeine therapy offers short-term benefits in apnea of prematurity

In very low birthweight infants with apnea of prematurity, caffeine increases the odds of survival without neurodevelopmental disability at 18 to 21 months, according to a report published in the Nov. 8 issue of the New England Journal of Medicine.

Barbara Schmidt, MD, of McMaster University in Hamilton, Ontario, Canada, and colleagues randomly assigned 2,006 infants with birthweights of 500 to 1,250 g to receive either caffeine or placebo.

Of the infants for whom adequate data were available on the primary outcome (death, cerebral palsy, and cognitive delay), the researchers found that the caffeine group was less likely to die or survive with a neurodevelopmental disability (40.2% vs. 46.2%). They also found that the caffeine group was significantly less likely to develop cerebral palsy (4.4% vs. 7.3%). At follow-up, however, they observed no significant group differences in the rates of death, deafness, and blindness, and the mean percentiles for height, weight, and head circumference.

"In the aggregate, the data from the current report of Schmidt et al., combined with the data from their earlier report, suggest that the temporary adverse effect of diminished weight gain for 3 weeks in infants treated with caffeine for apnea of prematurity is outweighed by the long-term benefit of improved survival without neurodevelopmental disability at 18 to 21 months," states the author of an accompanying editorial. "Nevertheless, longer follow-up is warranted, since the neurodevelopmental outcome at 18 to 21 months is not wholly predictive of later neurodevelopmental outcome and school performance."

Schmidt B, Roberts RS, Davis P, et al. Long-term effects of caffeine therapy for apnea of prematurity. N Engl J Med. 2007;357:1893-1902.