Caffeine Therapy for Apnea of Prematurity

CAP · New England Journal of Medicine · 2006

One of the few neonatal interventions with a demonstrated benefit on long-term outcome, not just a short-term physiological measure.

Caffeine reduced the incidence of bronchopulmonary dysplasia.

At 18–21 months, caffeine reduced the combined outcome of death or neurodevelopmental disability.

Rates of cerebral palsy and cognitive delay were lower in the caffeine group.

Follow-up at 5 and 11 years showed the early advantage narrowed over time.

Enrolment was left to clinician judgement about whether caffeine was indicated, so the population is not every preterm infant.

Dose and timing varied within the protocol.

The benefit on the primary composite attenuated by school age, which matters when the trial is cited as proof of lasting benefit.

Caffeine is a treatment with outcome evidence behind it, not only a respiratory stimulant.

Earlier initiation has been associated with greater benefit in later observational work, but that was not what this trial randomised.