Brain activity as a biomarker for personalised caffeine treatment in premature neonates

Medication in hospitalised infants is often prescribed using a ‘one-size-fits-all’ approach due to lack of clinical biomarkers. Caffeine is one of the most frequently administered medicines in neonatology - prescribed for the management of apnoea of prematurity, to aid extubation and increasingly for conditions such as bronchopulmonary dysplasia. Caffeine guidelines for the management of apnoea of prematurity indicate use based on age of the infant, but this does not account for individual variation in apnoea rate. Consequently, infants may risk caffeine undertreatment or adverse events due to over-exposure. Apnoea in preterm infants is related to brainstem immaturity, hence as an essential first step to assessing whether brain maturity may be a useful biomarker for caffeine treatment, we tested the hypothesis that apnoea rate is related to brain maturity. Using electroencephalography (EEG), we demonstrate that apnoea rate in late preterm infants is dependent on brain maturity, not postmenstrual age. We provide initial evidence that when caffeine is discontinued, infants with immature brain activity have more frequent apnoeas and desaturations compared with those with more mature brain function. These findings indicate that brain maturity (assessed automatically using machine learning) is a candidate biomarker for personalised caffeine treatment in preterm infants.