According to research published in the Journal of the American Medical Association, neonatal caffeine therapy is no longer associated with a significantly improved rate of survival without disability in children with very low birth weights who were assessed at 5 years.

Very preterm infants are prone to apnoea and have an increased risk of death or disability. Caffeine therapy for apnoea of prematurity reduces the rates of cerebral palsy and cognitive delay at 18 months of age. Researchers therefore evaluated 5-year data obtained from 31 academic hospitals in Canada, Australia, Europe, and Israel, where 1932 of 2006 participants (96.3%) had been enrolled in the randomised, placebo-controlled Caffeine for Apnoea of Prematurity trial, to determine whether neonatal caffeine therapy has lasting benefits or newly apparent risks at early school age. A total of 1640 children (84.9%) with birth weights of 500 to 1250 g had adequate data for the main outcome at 5 years.

Primary outcome measures were death or survival to 5 years with 1 or more of motor impairment (defined as a Gross Motor Function Classification System level of 3 to 5), cognitive impairment (defined as a Full Scale IQ<70), behaviour problems, poor general health, deafness, and blindness. The following results were reported:
• The combined outcome of death or disability was not statistically significantly different for the 833 children assigned to caffeine from that for the 807 children assigned to placebo (21.1% vs 24.8%; odds ratio adjusted for center, 0.82; 95% CI, 0.65-1.03; P = 0.09).
• The incidence of cognitive impairment was lower at 5 years than at 18 months but similar in the 2 groups (4.9% vs 5.1%; odds ratio adjusted for centre, 0.97; 0.61-1.55; P = 0.89).
• The rates of death, motor impairment, behaviour problems, poor general health, deafness, and blindness did not differ significantly between the 2 groups.

A related editorial discusses the study.