If your journey with newborn twins is anything like ours, it's safe to say you'll be consuming copious cups of coffee just to get through the newborn stage.
But that newborn stage with your babies might not begin at home immediately after they're delivered. It might start in the neonatal intensive care unit (NICU), like ours did.
Every pregnancy is different, so it may not always be the case, but many sets of twins and higher-order multiples arrive prematurely. Our twins (identical) arrived 6.5 weeks early. My niece and nephew (fraternal twins) also arrived 6.5 weeks early. My brother and I (fraternal twins) arrived almost 10 weeks early.
When babies are born early, chances are higher they'll run into complications before they can be discharged home.
If you have enough warning before delivery and the timing is right, you can ask your medical team about two shots that can help your babies' development before they're born.
Then, once you welcome your twins, there may be further interventions in the NICU that could be critically necessary for their health.
One lesser-known medication that's sometimes administered to premature babies can surprise some parents, but its benefits can literally be life-saving.
One lesser-known medication that's sometimes administered to premature babies can surprise some parents, but its benefits can literally be life-saving.
The medication? Caffeine citrate. You might hear it referred to as caffeine therapy.
When it's administered properly by trained professionals in a healthcare setting, caffeine can actually be beneficial to your babies if they were born early.
To be clear, caffeine isn't recommended for full-term babies; if they don't need it, they can experience side-effects, like sleep disruption or an increased heart rate.
But for babies who were born prematurely, caffeine therapy can be a very vital medical intervention.
Caffeine caveat
In case you're wondering, no, the doctors and nurses in the NICU aren't going to give your newborn preemies a cup of coffee through their feeding tube.
In a medical setting, pharmaceutical-grade caffeine citrate is administered at a very calculated time to premature babies with precise weight-based dosing (the initial dose given will be different than the maintenance doses that are administered in the following days).
Caffeine citrate is given through an intravenous line or as oral drops as part of a baby's feed (if your babies are tolerating enteral feeds), and it's used to improve both their pulmonary function and their neurodevelopment.
When babies are born prematurely, their brains haven't developed enough to allow them to do everything their bodies need to be able to do on their own.
When babies are born prematurely, their brains haven't developed enough to allow them to do everything their bodies need to be able to do on their own. A prime example of one of these things we take for granted is breathing.
According to the Journal of Perinatology, "infants born preterm are physiologically and metabolically immature and have higher rates of morbidity and mortality, and poorer long-term neurodevelopmental outcomes than those born at term…they are at risk of apnea of prematurity and intermittent hypoxemia (low blood oxygen), which result in a decrease in oxygen saturation and bradycardia and have been associated with increased risk of neurodevelopmental impairment."
The article goes on to say that the instances of apnea are correlated with how premature a baby is, occurring most often in extremely preterm infants (though, late preterm infants are also affected). Late preterm infants also experience frequent episodes of intermittent hypoxemia and poorer neurodevelopmental outcomes than full-term babies.
In their first weeks of life, preemies expend so much energy when they're feeding that they tend to slow down and get sleepy. When this happens, they can even forget to breathe.
When they forget to breathe, this can cause their heart to slow down, when means they aren't getting enough oxygen, and that's why you tend to see very premature babies wearing so many leads to monitor their vitals (their blood oxygen levels, heart rate, etc.).
Three vital ways caffeine can benefit premature babies
After antibiotics, caffeine is the most commonly used drug in the NICU. It acts as a catalyst for a premature baby's underdeveloped central nervous system and the respiratory center in their brain, helping them remember to breathe. It also stimulates their diaphragm and lungs.
A study conducted by researchers from the University of Calgary shows the sooner a dose of caffeine is given, the better the benefits are for the premature baby.
Administered by healthcare professionals as caffeine citrate within the first few days of life, this routinely used drug can have long-lasting benefits for both cognitive and pulmonary outcomes in babies who are born early.
Widely used in NICUs for premature babies, caffeine helps neonates in three vital ways:
- Stimulating Underdeveloped Lungs & Reducing Apnea: Caffeine therapy helps prevent dangerous pauses in breathing (called apnea of prematurity). Because preemies are born with underdeveloped central nervous systems, their brains can actually "forget" to tell their lungs to breathe, so caffeine citrate sends regular signals from their brain to their lungs. It also reduces repetitive drops in blood oxygen levels (called intermittent hypoxia) and enhances muscle function.
- Protecting & Developing the Brain: Caffeine therapy supports a baby's fragile, developing brain and enhances neural connectivity, resulting in higher cognitive scores and stronger motor development. It also lowers a baby's chances of developing Cerebral Palsy by about 35 percent.
- Preventing Chronic Lung Disease & Speeding Up Independence: Caffeine therapy improves a baby's cardiac output and blood pressure, helping them transition from needing a ventilator to breathing on their own much sooner. As a result, it reduces the risk of Bronchopulmonary Dysplasia, a chronic lung condition that's caused by mechanical airway damage.
Are there long-term effects from babies receiving caffeine citrate?
Caffeine therapy has been used in the NICU to help premature babies for decades, and studies have shown it's both safe and effective, with no negative long-term effects.
In fact, a study on neurobehavioral outcomes 11 years after neonatal caffeine therapy for apnea of prematurity that was published by the American Academy of Pediatrics found that "neonatal caffeine therapy for apnea of prematurity improved visuomotor, visuoperceptual, and visuospatial abilities at 11 years" and that general intelligence, attention, and behavior weren't adversely affected by caffeine, highlighting the long-term safety of caffeine therapy for apnea of prematurity in very low birthweight neonates.
Studies also show that caffeine doses administered to premature infants actually reduces the risk of bronchopulmonary dysplasia, a chronic lung disease that's common in premature, very low birthweight infants.
Caffeine citrate also helps with the stretch and expansion of lungs, allowing them to function better and, therefore, reducing the need for mechanical ventilation.
With improved lung function comes better cardiac output and an increased oxygen supply to your babies' entire bodies, including their brains, resulting in improved long-term cognitive and pulmonary outcomes, all thanks to the correct dose of caffeine given at the right times.
Be on the lookout once your babies come home
It's important for parents to know that once their preemies graduate from the NICU and get to go home, there's a chance they might still randomly forget to breathe in those early days, while their brains continue to develop to where they "should have been" if the babies had been born full-term.
I don't say this to scare anyone; I say it because it happened to us with our twins.
I don't say this to scare anyone; I say it because it happened to us with our twins.
As I mentioned, our identical twins were born 6.5 weeks early, so their respiratory systems were still developing and shifting from the fluid-filled environment they were used to in the womb to one of breathing air.
Fortunately, we didn't run into any breathing issues with our twins overnight, but there was one instance where one of our babies stopped breathing the very first day he was at home.
My husband was holding and watching him, so, fortunately, he noticed right away and gently poked our baby's tummy to remind him to take his next breath. Once he was poked, our baby took his next breath right away, and was fine after that.
But if we didn't know to watch for this possibility, we might not have known what to do. Luckily, the NICU team had warned us this might happen, and because they'd given us a heads-up to be on the lookout for a pause in breathing, my husband knew what to do, and everything worked out fine.
Calculated therapy
When used in a precise and calculated way by healthcare professionals, caffeine therapy can actually have positive impacts for premature babies, bringing about long-term benefits to your babies.
It can help with lung function and regulate their breathing to reduce pauses where they forget to breathe.
Caffeine citrate can also decrease bradycardia episodes, leading to better blood oxygen levels and improved cognitive and pulmonary outcomes for your babies.
Were your twins born prematurely? Did they receive caffeine therapy in the NICU? What do you think about the use of caffeine citrate for critical intervention in the hospital? Let us know in the Comments section below or connect with us on Instagram to share your thoughts!
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