Efeito da cafeína na prevenção da paralisia cerebral: revisão sistemática

Abstract

Cerebral Palsy (CP) is the most common cause of severe physical disability in childhood and prematurity is a significant risk factor for CP. Despite the pharmacological treatment of CP being widely studied, few studies have correlated the administration of neuroprotective compounds and the improvement of clinical parameters and survival of patients affected by this disease. Among the substances studied, caffeine has been associated with the treatment of neurological disorders, with potential application to prevent CP, especially those whose origin is in peri- and postnatal causes. The aim of this study was to systematically review the effects of caffeine in preventing CP. Taking as eligibility criteria pregnant women or premature newborns at risk of developing brain damage, who used caffeine in the form of caffeine citrate administered in the first days of life in the child or exposure of the pregnant woman during the perinatal period or administered in periods different and compared to each other. The comparison involved: children or pregnant women who did not receive the tested intervention/exposure or children or pregnant women who received doses different from that tested or without a control or placebo intervention. Primary outcomes included the incidence of CP. And the secondary outcomes were those related to neurological development, motor and cognitive development, in addition to outcomes related to growth and development. The types of studies included were controlled clinical trials or Cohort studies. The identification of studies was performed in Medline, Embase, Cochrane Library databases, including the Cochrane Controlled Trials Register, Scopus and Web of Science. Survey conducted on April 19, 2021. Reference lists of relevant clinical trials and reviews were also consulted. The methodological quality of the risk of bias of the selected randomized clinical trial was assessed using the tool proposed by the Joanna Briggs Institute (Critical Appraisal Tools for use in JBI Systematic Reviews – Checklist for Randomized Controlled Trials). For cohort studies, the methodological quality of the Risk of bias of the included studies was assessed using the tool also proposed by the Joanna Briggs Institute (Critical Appraisal Tools for use in JBI Systematic Reviews – Checklist for Cohort Studies). Five studies from seven publications were included in this review. Regarding study designs, one was a placebo-controlled randomized clinical trial (N=2006), a prospective cohort study (N=95,200) and five retrospective cohort studies published between 2007 and 2019 and carried out in Australia, Canada and Norway . Mean gestational weeks at birth ranged from 25 to 28 weeks and birth weights from 850g to 1010g. One study did not use a caffeine intervention, but rather assessed caffeine consumption through food/beverage sources. Five studies reported a favorable effect of caffeine on the primary outcome (incidence of CP). A qualitative synthesis of the included studies was carried out, since the lack of homogeneity prevented a quantitative synthesis of the results. Among the limitations found, we can report the small number of studies, the lack of uniformity in the standards that were analyzed in the studies, and the methodological heterogeneity. Thus, with the lack of uniformity in the studies analyzed, it was not possible to generate a more concrete conclusion on the subject. Regarding the safety of the intervention, the result is still inconclusive because the studies did not evaluate the adverse effects, only the clinical trial. In this sense, caution is required, as it is not yet possible to reach a conclusion about the safety of the intervention. The favorable effect may exist, however, it cannot yet be confirmed due to the low strength of the evidence on the effect of caffeine on CP.