What are the side effects of caffeine in neonates?
Some reports have described caffeine toxicity-related tachycardia, tachypnea, irritability, jitteriness, and vomiting in preterm neonates. Signs of caffeine toxicity include tachycardia, leukocytosis, hyperglycemia, hypokalemia, emesis, lactic acidosis, and seizure-like movements (8).This is most likely because caffeine stimulates the nervous system, increasing the possibility of elevated stress and anxiety levels and, thus, psychogenic seizures.Caffeine overdose (36 mg/kg to 136 mg/kg) and perinatal asphyxia may precipitate or increase seizure activity in term neonates [92]. Early high-dose caffeine (80 mg/kg) is associated with an increase in seizure incidence and seizure burden in premature infants ≤30 weeks GA [93].Typically, babies are weaned off caffeine once they’re developmentally mature enough to breathe normally without help, usually around 34 weeks’ gestational age.Carefully giving neonates caffeine stimulates the brain, helping them to remember to breathe, and stimulates their diaphragm and lungs.
What are the symptoms of caffeine toxicity in newborns?
The infants received caffeine in doses that ranged from 36 to 136 mg/kg. On arrival in a regional newborn center, they exhibited one or more of the following symptoms: tachypnea, fine tremor of the extremities, opisthotonus, tonic-clonic movements, and nonpurposeful jaw and lip movements. Caffeine is usually stopped after the baby has been apnea-free for a few days or once they reach 34 weeks corrected age. Caffeine stays in the body for about 5 to 7 days, so the baby needs to remain in the NICU to monitor for recurrence of apnea.Fussiness, jitteriness and sleeping problems have been found in babies whose mothers consumed high levels of caffeine, more than 5 cups of coffee each day. There is no agreed upon safe level of caffeine because every baby’s tolerance is different.By stimulating the brain and reminding them to breathe, caffeine treatment allows babies to receive the benefits of higher oxygen saturation while reducing the toxic effects of exposure,” he said.While adults metabolize caffeine in about four hours, the half-life in newborns can be as long as 100 hours. Caffeine remains in an infant’s system for weeks, not hours.
What is the action of caffeine citrate in neonates?
Table 1 summarizes the properties and the effects of caffeine citrate for the treatment of apnea of prematurity in neonates. It increases the mean respiratory rate, stimulates respiratory centers, increases pulmonary blood flow and increases the sensitivity of central medullary areas to hypercapnia. Caffeine citrate injection is used to treat short-term apnea of prematurity when premature babies (infants between 28 and 32 weeks gestational age) stop breathing. Apnea of prematurity is caused by the baby’s breathing centers not being fully developed.To avoid unnecessarily prolonging admissions, stop caffeine at 35 weeks PMA unless the baby has ongoing apnoea. Rapid infusion of caffeine citrate may precipitate cardiac arrhythmias.Caffeine is the most commonly used medication for treatment of apnea of prematurity. Its effect has been well established in reducing the frequency of apnea, intermittent hypoxemia, and extubation failure in mechanically ventilated preterm infants.It is a neuro-stimulant that stimulates central respiratory drive, increasing medullary respiratory centers sensitivity to carbon dioxide and improving diaphragmatic contractility [12]. It decreases but does not eliminate apnea [13]. Caffeine also provides pain relief when used together with common analgesics [14].Caffeine gets into breast milk in small amounts. It has been suggested to limit daily consumption to 300 mg/day or less while breastfeeding. If you suspect the baby has any symptoms (agitation, irritability, trouble with sleeping, rapid heart rate or tremor), contact the child’s healthcare provider.
Is caffeine citrate safe for babies?
Appropriate studies performed to date have not pediatric-specific problems that would limit the usefulness of caffeine citrate injection in premature babies. It is recommended that caffeine citrate administration should be stopped when the patient has 5-7 days without a significant apnoeic attack.