Abstract
(1) Background: Caffeine citrate, at standard doses, is effective for reducing the incidence of apnea of prematurity (AOP) and may confer neuroprotection and decrease neonatal morbidities in extremely low gestational age neonates (ELGANs) requiring oxygen therapy. We tested the hypothesis that high-dose caffeine (HiC) has no adverse effects on the neonatal brain. (2) Methods: Newborn rat pups were randomized to room air (RA), hyperoxia (Hx) or neonatal intermittent hypoxia (IH), from birth (P0) to P14 during which they received intraperitoneal injections of LoC (20 mg/kg on P0; 5 mg/kg/day on P1-P14), HiC (80 mg/kg; 20 mg/kg), or equivalent volume saline. Blood gases, histopathology, myelin and neuronal integrity, and adenosine receptor reactivity were assessed. (3) Results: Caffeine treatment in Hx influenced blood gases more than treatment in neonatal IH. Exposure to neonatal IH resulted in hemorrhage and higher brain width, particularly in layer 2 of the cerebral cortex. Both caffeine doses increased brain width in RA, but layer 2 was increased only with HiC. HiC decreased oxidative stress more effectively than LoC, and both doses reduced apoptosis biomarkers. In RA, both caffeine doses improved myelination, but the effect was abolished in Hx and neonatal IH. Similarly, both doses inhibited adenosine 1A receptor in all oxygen environments, but adenosine 2A receptor was inhibited only in RA and Hx. (4) Conclusions: Caffeine, even at high doses, when administered in normoxia, can confer neuroprotection, evidenced by reductions in oxidative stress, hypermyelination, and increased Golgi bodies. However, varying oxygen environments, such as Hx or neonatal IH, may alter and modify pharmacodynamic actions of caffeine and may even override the benefits caffeine.
Highlights
room air (RA), both caffeine doses resulted in blood gases that were comparable with placebo saline
high-dose caffeine (HiC) was more effective for than LoC in suppressing oxidative stress. 8-OHdG increased in the placebo saline group exposed to Hx and neonatal intermittent hypoxia (IH), and in response to both caffeine doses, the levels were higher in Hx and neonatal IH than
Caspase-increased in the Hx and neonatal IH groups treated with placebo saline, with the highest elevation noted with neonatal IH exposure
Summary
Animal studies and neonatal clinical trials on high caffeine doses have reported adverse molecular and cellular effects on the developing brain, increased cerebral injury, and abnormal motor performance [40,41]. The effects of high caffeine doses on the neonatal brain when administered in neonatal IH remains to be determined. Based on our previous findings and the known anti-inflammatory, anti-apototic, antioxidant, and antiproliferative properties of caffeine in hypoxia-induced neonatal brain injury [56,57], we tested the hypothesis that high caffeine doses confer no significant adverse effects in the brain of neonatal rats exposed to IH. IH-induced biomarkers of oxidative stress, DNA damage, and apoptosis in the neonatal brain; and (3) to examine the inhibitory effects of high caffeine doses on brain adenosine receptors in neonatal IH. The primary outcomes were histopathology and myelination, and the secondary outcomes were morphometry, oxidative stress and apoptosis biomarkers
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