Acute caffeine overdose in the neonate
W. Banner Jr and P. A. Czajka
To our knowledge, the clinical course of acute caffeine poisoning in
neonates has not been previously reported. Three full-term infants
manifested CNS irritability after the parenteral administration of large
doses of caffeine and benzoate sodium injection in the delivery room for
respiratory depression. The infants received caffeine in doses that ranged
from 36 to 136 mg/kg. On arrival in a regional newborn center, they
exhibited one or more of the following symptoms: tachypnea, fine tremor of
the extremities, opisthotonus, tonic-clonic movements, and nonpurposeful
jaw and lip movements. The overdose of caffeine produced a clinical picture
that suggested neonatal seizures and prompted therapy with anticonvulsants.
A fourth infant (premature) attained a high plasma caffeine concentration,
but this infant's symptoms were altered by intraventricular hemorrhage. The
combination of caffeine overdose and perinatal asphyxia may precipitate or
increase seizure activity in the neonate. Recognition of the potential
toxic effects of caffeine overdose should guide patient care and stimulate
further study to establish appropriate use of caffeine in the newborn
infant.
