A new prevention track under study

The sudden death of the infant remains a major cause of death in infants under six months of age. In France, according to Public Health France, each year, 250 to 350 babies each die of unexpected death of the infant (Min). We speak of sudden infant death (MSN) in the absence of an explanation. This form represents half of the cases of min. France is one of the European countries where the prevalence is the highest.

If the exact causes of the sudden death of the infant are still poorly understood, several tracks are explored, in particular the role of intermittent hypoxia (HI), abnormalities in respiratory control, and serotonin. Caffeine, a substance widely used in neonatology to treat apnea, appears as a potentially protective substance in this context.

Intermittent hypoxia and neonatal vulnerability

Intermittent hypoxia is frequent in premature infants, in connection with an immaturity of respiratory control. Although it can stimulate the respiratory adaptive mechanisms, it is also associated with serious complications in these small (bronchopulmonary dysplasia, retinopathy, neurodevelopmental, even death disorders). On the neurobiological level, the HI promotes oxidative stress, inflammation, hypomyelization, and disrupts neuronal migration, in particular in the hippocampus.

Potential protective role of caffeine

Caffeine is used to treat apnea in prematurers and has shown its effectiveness to reduce HI, improve ventilation, and promote self-resuscitation after an episode of asphyxiation. In animal models with serotonin, it accelerates reflex “fatty”, stabilizes heart rate, and improves survival. These effects make caffeine a potential candidate to interrupt the pathophysiological waterfall leading to the sudden death of the infant.

Neonatal caffeine metabolism

In infants, caffeine is slowly metabolized, with a half-life that decreases with age. During the first three months of life, it remains the main element detected in the urine. In adults, caffeine is metabolized in about 4 hours while its half-life in newborns can reach 100 hours. This prolonged persistence is notable because it coincides with the critical risk period of MSN (2–4 months). The speed of metabolism can also vary depending on the genetic profile and ethnic origin.

Breastfeeding, caffeine and prevention of MSN

Caffeine is transmitted to infants via breast milk, with a peak observed between 0.75 and 2 hours after maternal ingestion. The levels detected in the serum of infants remain moderate but biologically active. Some researchers argue that the protection observed in breastfed infants against MSN could be partially linked to this caffeine exhibition. However, other studies suggest that a brutal caffeine weaning after birth could, on the contrary, increase the risk of MSN, by disturbing the development of the respiratory center.

Safety and variability of exposure

In breastfeeding women, moderate caffeine consumption is generally safe for infants. The reported side effects are limited to sleep or irritability disorders. On the other hand, the consequences of excessive prenatal exposure include an increased risk of small birth weight, obesity, or neurocomptal disorders in animal models, without clear confirmation in humans. It is therefore essential to better understand the benefit/risk of a caffeine neonatal exhibition in a preventive perspective against the MSN.

The authors recall that the risk of MSN is warned by adopting the right gestures. To know:

  • Sleep position on the back
  • Good part of the part
  • Pacifier use
  • Avoid tobacco and cododo.

Source : Reducing the risk of sudden unexpected infant death: the caffeine hypothesis

Comments (0)
Add Comment