Could caffeine help late preterm babies?

Researchers are exploring whether giving small doses of caffeine to babies born up to six weeks early might help prevent brain damage. Photo / 123RF

Researchers are exploring whether giving small doses of caffeine to babies born up to six weeks early might help prevent brain damage.

Late preterm babies – or those born four to six weeks early – make up about 6 per cent of the 3700 births recorded each year in New Zealand.

But, compared with babies born at term, they have a 30 per cent increased risk of brain damage.

In very preterm babies - those born more than eight weeks early - drops in oxygen levels were common in the weeks following birth, were also associated with brain damage.

Treatment with caffeine not only improved oxygenation in these babies, but also improved brain development, said Liz Oliphant, a senior paediatric pharmacist at Starship Child Health and University of Auckland PhD candidate.

"Recently it has been identified that babies born late preterm remain at increased risk of intermittent drops in their oxygen levels, though they rarely display immediate and obvious effects of this, and we believe that this may be linked to their increased risk of developing brain damage."

In a project dubbed the Latte Dosage Trial, Oliphant and colleagues are investigating whether caffeine also might help these babies and, if so, what the best dose would be.

"The dose of caffeine used in very pre-term babies is well established, but as the late pre-term group are slightly older their kidneys and liver function better and remove medicines faster, and it is thus likely they will require a higher dose of caffeine than very pre-term infants."

The randomised, controlled trial would compare caffeine citrate at different strengths against water as a placebo, in late preterm babies born at Auckland and Middlemore hospitals.

They will be randomly assigned to receive either placebo or caffeine at one of four strengths within the first three days of their life.

"This medicine will be given daily until the baby's original due date," Oliphant said.

"Their blood-oxygen levels will be measured at three time points during the study – prior to beginning treatment, then at two weeks of age, and then at the baby's original due date – using overnight oximetry, which measures oxygen saturation continuously while the baby sleeps."

Mothers will be asked to complete questionnaires on any possible side effects that they may notice in their babies, as well as how they are feeling and their intake of foods and drinks that may contain caffeine.

"In addition, as part of my PhD studies I will conduct associated research, including establishing the stability of the caffeine liquids used in the trial and measuring the levels of caffeine in both babies' and mothers' saliva to assess the extent and impact of non-prescribed caffeine ingested via breast milk," she said.

"Subsequent studies can then use this information to develop trials that assess the effect that caffeine given to late preterm babies in early life has on brain function as babies grow up."

Oliphant expected recruiting participants for the trial would be challenging.

"The parents we are asking to be involved have recently given birth to their baby several weeks early – often unexpectedly – and are understandably shocked and concerned. Enrolling their baby in a clinical trial is generally the last thing on their mind.

"We are grateful for those who do decide to participate and allow us to gather evidence to continue to inform the best way to treat these babies to improve their long-term outcomes."

Her ultimate hope was the research would make a clinical difference to babies here and around the world.

"This will also inform the development of further studies, which will be able to look at the effect of caffeine treatment on brain development in late preterm infants."

The three-year study is being supported with a $319,995 grant from the Health Research Council.