Impact of caffeine therapy on neurodevelopment: Bayley Scales of Infant Motor Development (BSID-III) article summary
Purpose: The purpose of this study was to determine the impact on neurodevelopment for very low birth weight (VLBW) newborns who received caffeine therapy within 48 hours of birth.
Study population: The population used in this study were 160 newborns who met the 32-week gestational age requirement and were discharged from the neonatal intensive care unit (NICU).
Methods: The study was performed retroactively and used a cohort of newborns that were between 18-22 months of post-menstrual age (PMA). Data was collected on each participant including day of life when the caffeine therapy was started and other data about the clinical course. The participants were put into 3 categories: no caffeine, caffeine therapy started before 48 hours of life, caffeine therapy started after 48 hours of life. The data was taken from the participants charts from the clinic or hospital they were seen at. From the chart, the language, cognitive, and motor parts of the BSID III were reviewed from the 18-22 months period. The BSID III scores were categorized by lowest score from each domain by normal, moderate, or severe disability. The statistical analysis used was a chi-squared test and Mann-Whitney U or Kruskal-Wallis test.
Outcome measures: The Bayley Scale of Infant Development III was used in this study. Additionally, Apgar scores at 5 min were used when determining clinical course in the hospital.
Interventions: The intervention that was examined retroactively was the use of caffeine therapy before and after 48 hours of life in this newborn population.
Results: This study found that there was not a significant difference between the caffeine groups for birth weight, race, gestation age, gender, Apgar score at 5 min, or chorioamnionitis. Additionally, when looking at perinatal clinical characteristics, the study found that the early caffeine group had a higher percentage of receiving antenatal steroids than the other groups. Post-natally, the late group had a significantly higher day of life for initiation of caffeine therapy than the early group. All other clinical course parameters explored were not statistically significant between the 3 groups. In all 3 categories of the BSID-III, the early group had higher percentages of newborns with normal scores than the other 2 groups. Similar results were seen for newborns when looking at the difference with the presence or absence of chorioamnionitis.
Conclusion: The overall conclusion that the author of this article made was that VLBW newborns who received caffeine therapy within 48 hours of life had better neurodevelopmental outcomes at 18-22 months.
Strengths/Weaknesses: A strength of this study was that the study was able to compare different times of receiving the caffeine therapy as well as those who received no caffeine. Additionally, utilizing the data on clinical course perinatal and post-natal allowed for a broader picture to be painted for what could truly be contributing to the higher BSID-III scores. Doing the study retroactively was a weakness of this study due to some of the information being incomplete and needing to be excluded. Additionally, the study only looked at the neurodevelopment of these newborns in a close time range and was not extended to later periods of development. In the future, I believe it would be beneficial to look at these participants neurodevelopment across a longer or more frequent spans of time.
Reference: Gupte AS, Gupta D, Ravichandran S, Ma MM, Chouthai NS. Effect of early caffeine on neurodevelopmental outcome of very low-birth weight newborns. J Matern Fetal Neonatal Med. 2016;29(8):1233-1237. doi:10.3109/14767058.2015.1041493
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