This may sound strange, but it’s actually very common for babies born very prematurely to be given caffeine to help give their development a boost.
Currently Prof. Charles Roehr and his team are running a Caffeine Metabolism study (PEPICaff) aiming to analyze and get sufficient data on caffeine metabolism and excretion in extremely preterm babies in the first week of life. During my time in Oxford I had the chance to get a closer look at this study and take part in the data assessment, which was a very interesting completion on studying the theory of caffeine appliance.
So, how’s caffeine actually helping?
Two thirds of extremely preterm infants (<29 weeks of gestational age) will need intubation and mechanical ventilation due to a lack of surfactant and lack of respiratory drive. Ventilating the very delicate lung tissue can cause damage as chronic scarring and diseased lungs. For that reason intubation and mechanical ventilation are now avoided whenever possible, focusing more on non-invasive ventilation techniques.
Caffeine is a trimethylated xanthine which antagonizes the respiratory suppressant effect of adenosine. It has been proved to be the most suitable agent to support spontaneous breathing in preterm infants. Caffeine has been demonstrated to increase respiratory neural output, enhance CO2 responsiveness, improve diaphragmatic contractility and induce the transcription of various surfactant protein B transcription factors.
Quite smart, huh? ;-)
Sources:
Pepicaff protocol
Morley CJ, Davis PG, Doyle LW, Brion LP, Hascoet JM, Carlin JB, et al. Nasal CPAP or intubation at birth for very preterm infants. N Engl J Med. 2008;358(7):700-8.
Aranda JV, Beharry K, Valencia GB, Natarajan G, Davis J. Caffeine impact on neonatal morbidities. J Matern Fetal Neonatal Med. 2010;23 Suppl 3:20-3.
Clark RH, Bloom BT, Spitzer AR, Gerstmann DR. Reported medication use in the neonatal intensive care unit: data from a large national data set. Pediatrics. 2006;117(6):1979-87.
Schmidt B, Roberts RS, Davis P, Doyle LW, Barrington KJ, Ohlsson A, et al. Caffeine therapy for apnea of prematurity. N Engl J Med. 2006;354(20):2112-21.
Abu-Shaweesh JM, Martin RJ. Caffeine use in the neonatal intensive care unit. Semin Fetal Neonatal Med. 2017;22(5):342-7.
Very happy to hear you enjoyed your time with us so much. You are an exemplary student - do come back soon. It’s great to read about your many positive experiences and how the Roland Wauer Award has helped you to experience this.