From breastmilk to intervention: Caffeine may prevent sudden infant death syndrome

Caffeine may protect babies by preventing dangerous drops in oxygen that can cause death, a new Rutgers Health study finds. Sudden Unexpected Infant Death (SUID) is the leading cause of infant deaths between one and 12 months old.

Published in the Journal of Perinatology, the researchers’ hypothesis reveals that the number of SUID cases has plateaued in the US at about 3,500 deaths annually for 25 years. The 1990s only saw an initial decline in SUID cases due to increased education campaigns promoting back-to-sleep and safe infant sleep recommendations by the American Academy of Pediatrics.

“We’ve been concerned about why the rates haven’t changed,” says lead researcher Thomas Hegyi, neonatologist at Rutgers Robert Wood Johnson Medical School, US. “So, we wanted to explore new ways of approaching the challenge.”

The research team draws a link between sudden infant death syndrome (SIDS) and other sleep-related infant deaths, maternal smoking, stomach sleeping, and bed-sharing to preterm birth to intermittent hypoxia. These are short moments where oxygen levels drop below 80%.

“I wondered, what can counter intermittent hypoxia?” Hegyi questioned. “Caffeine.”

Early protection from breastmilk? 

Neonatologists already use caffeine to treat apnea in premature infants, used as a respiratory stimulant. The researchers note caffeine is safe for babies with minimal side effects even at high doses.

Infants process caffeine differently, remaining in their system for weeks, while adults metabolize caffeine in around four hours. 

The researchers suggest that caffeine consumed during pregnancy or passed through breastmilk might provide initial protection but wanes as metabolism speeds up. SIDS is especially high between two and four months.

“We hypothesize that the protection afforded by breastmilk is, in part, due to caffeine,” write the researchers, noting caffeine readily passes from mothers to infants through breastmilk.

If the hypothesis is true, then providing infants caffeine would complement and not replace existing risk strategies, says co-author Barbara Ostfeld, a professor at Rutgers Robert Wood Johnson Medical School and the program director of the SIDS Center of New Jersey.

The researchers suggest that caffeine consumed during pregnancy or passed through breastmilk might provide initial protection. “A baby dying from accidental suffocation, one component of SUID, is not likely to have benefited from caffeine but would have from such safe sleep practices as the elimination of pillows and other loose bedding from the infant’s sleep environment.”

Just a hypothesis

The researchers caution parents from giving their baby caffeine as they plan to test their hypothesis, comparing caffeine levels in infants who died of SIDS and those who died from other causes.

Hegyi says the goal is “to stimulate new thinking about a problem that has remained unchanged for 25 years.” 

Current strategies focus on removing environmental risk, while their hypothesis could be the first potential pharmaceutical intervention.

“For over 30 years, we’ve been educating New Jersey’s parents about adopting safe infant sleep practices. These efforts have contributed to our state rates being the second lowest in the US. Still, for various reasons, these proven recommendations are not universally adopted,” says Ostfeld. 

“This new hypothesis offers a way not just to address important risk factors but potentially intervene.”