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Neonatal caffeine therapy may improve visuomotor, visual perception outcomes
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Neonatal caffeine therapy for apnea of prematurity in very low birth weight infants showed improved visuomotor, visuoperceptual and visuospatial outcomes at age 11 years compared with infants who did not receive the therapy, according to study results published in Pediatrics.
“Apnea of prematurity occurs in over 50% of preterm neonates and is most commonly created with respiratory stimulants such as caffeine,” Ines M. Mürner-Lavanchy, PhD, of Monas Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Australia, and Murdoch Children’s Research Institute, Melbourne, Australia, and colleagues wrote. “However, short- and long-term effects of caffeine on the central nervous system are not clearly understood, with both neuroprotective and neurotoxic effects being reported in experimental evidence. In addition, caffeine may be indirectly associated with better developmental outcomes by reducing apnea and the duration of mechanical ventilation.”
Mürner-Lavanchy and colleagues measured the effects of neonatal caffeine therapy in very low birth weight infants during the first 10 days of life who were enrolled from October 1999 to October 2004 at 35 academic hospitals an nine countries.
There were 2,006 Infants with birth weights of 500 g to 1,250 g who were candidates for methylxanthine therapy during their first 10 days of life enrolled in the study. Treatment of caffeine citrate or normal saline placebo was randomly assigned until treatment was no longer needed for apnea of prematurity.
An 11-year follow-up of the double-blind study was held in 13 hospitals in Canada, Australia, Great Britain and Sweden. Data from 870 children were used to determine general intelligence, attention, executive function, visuomotor integration and perception and behavior. Regression models were used to measure effects of caffeine therapy.
The children in the caffeine cohort and the placebo cohort had similar neurobehavioral outcomes, with mean scores higher on most scales for the caffeine cohort.
Visuomotor integration (mean difference [MD] = 1.8; 95% CI, 00-3.7), fine motor coordination (MD = 2.9; 95% CI, 0-3.7), visual perception (MD = 2.0; 95% CI, 0.3-3.8), visuospatial organization (MD = 1.2; 95% CI, 0.4-2.0) and Rey complex figure test copy accuracy (MD =1.2; 95% CI, 0.4-2.0) showed higher evidence for group difference in the caffeine cohort compared with the placebo cohort.
The caffeine cohort had lower odds than the placebo cohort of visual impairment for visuomotor integration (OR = 0.74; 95% CI, 0.5-0.99), visual perception (OR = 0.63; 05% CI, 0.43-0.92) and fine motor coordination (OR = 0.69; 95% Ci, 0.52-0.92).
“We found specific benefits of neonatal caffeine therapy in the visuomotor domain and no evidence of harmful effect on neurobehavioral outcomes up to 11 years of age,” the researchers wrote. “The caffeine benefit we observed in fine motor coordination and visuomotor integration is consistent with our previously reported association of neonatal caffeine therapy with a reduced risk for motor impairment at 18 months, 5 years and 11 years, improved fine motor coordination at 5 years and lower rates of [developmental coordination disorder] at 5 years.” – by Bruce Thiel
Disclosures: The authors report no relevant financial disclosures.
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