Caffeine for breathing problems in premature babies

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Large variations in the treatments used for a particular condition provide clear evidence of professional uncertainty about the relative merits of different treatments. And entrenched practices may mean that it takes a very long time for such uncertainties to be addressed by fair tests.

The use of caffeine in premature babies provides a telling example. Such babies often have trouble breathing properly and sometimes stop breathing very briefly – this condition is known as apnoea of prematurity and affects most babies born at less than 34 weeks’ gestation. In the late 1970s, caffeine treatment was shown to reduce these episodes and then became used by some paediatricians.

However the effects of caffeine remained disputed. Although fair tests had shown that caffeine reduced the episodes of apnoea, many paediatricians did not think that the episodes were sufficiently serious to justify use of the drug, and some were concerned that it might not be safe in these tiny babies. This meant that some babies were given the treatment and others weren’t.

When these widespread uncertainties were finally assessed by a large international study more than 30 years after the treatment had been introduced, it turned out that this simple therapy not only reduces the breathing difficulties but also, and very importantly, significantly improves the likelihood of long-term survival without cerebral palsy and delay in infant development. Had this uncertainty been addressed when the treatment was introduced, fewer babies would have gone on to develop disabilities.[15], [16]

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