Scenario

A 29-week gestation neonate is having frequent apnoeas while on continuous positive airway pressure, so you prescribe caffeine to help prevent apnoeas of prematurity. You notice another baby of the same gestation is not on caffeine but recall reading caffeine treatment may reduce future neurodevelopmental disability. You wonder how strong the evidence is and whether all neonates under 32 weeks gestation should be on caffeine treatment.

Structured clinical question

In premature neonates under 32 weeks gestation [population], does caffeine [intervention] improve subsequent neurodevelopment [outcome]?

Search strategy and outcome

Medline via PubMed was the primary source of articles. The search was via ‘Clinical queries’ using the broad, sensitive filter and search terms: [caffeine AND develop*]. A second search using [methylxanthine AND develop*] was also performed. Limits were: humans and All children (from birth to 12 years). Dates included 1966 to October 2009.

Secondary searches on the Cochrane Database, Clinical Evidence and SUMsearch were performed using the same search terms.

The search was performed independently by two people. A total of 27 papers were found via PubMed, three of which were relevant (table 1). The references of the above papers were scanned, along with the linked articles, but no further …