Caffeine and other methyl xanthines are widely used in the neonatal period. A recent, randomized, placebo-controlled, multicenter trial found that infants who were randomly assigned to caffeine treatment had less need for pharmacologic and/or surgical closure of a patent ductus arteriosus (PDA). We hypothesized that the decreased need for pharmacologic and surgical closure of the PDA after caffeine treatment might be due to a direct effect of caffeine on ductus contractility. We examined preterm fetal lamb ductus arteriosus (from 24 fetuses, 105 Ϯ 4 d of gestation, term ϭ 147 d), in vitro to determine the direct effects of caffeine on the isometric tension of the ductus arteriosus. Caffeine (0.003-0.3 mM) had no direct effect on ductus arteriosus tension, nor did it affect the contractile response of the ductus arteriosus to increasing oxygen concentrations. Caffeine's lack of effect was observed in both the presence and absence of indomethacin and N g -nitro-L-arginine methyl ester (L-NAME) (inhibitors of prostaglandin and nitric oxide production). In conclusion, we found no evidence of a direct effect of therapeutic caffeine concentrations on ductus contractility. ) (1-10), in vivo studies suggest that postnatal constriction is primarily determined by a shift in the balance between oxygen (a ductus constrictor) and prostaglandins and nitric oxide (ductus dilators) (11,12). Alterations in antenatal glucocorticoid concentrations and postnatal pulmonary vascular resistance also play roles in in vivo ductus constriction (13,14).Recently, a randomized, placebo-controlled, multicenter trial was performed to evaluate the effects of caffeine administration in preterm infants (15). Infants were enrolled in the trial during the first 10 d after birth, and the primary goal of the study was to evaluate the long-term effects of caffeine on neurodevelopmental outcome. An unexpected finding of the study was that infants who were randomly assigned to caffeine treatment had less need for pharmacologic and/or surgical closure of a PDA.Caffeine has been found to directly affect several of the signaling molecules that are involved in ductus constriction: it increases cAMP by inhibiting cyclic nucleotide phosphodiesterase (16); it releases Ca 2ϩ from the endoplasmic reticulum by binding to the ryanodine receptor (17); it inhibits both prostaglandin production (18) and activity (19) and inhibits adenosine activity by binding to its receptors (20). At therapeutic concentrations, caffeine's effects appear to be due primarily to antagonism of the adenosine receptor (21).In this study, we hypothesized that the decreased need for pharmacologic and surgical closure of the PDA after caffeine treatment might be due to a direct effect of caffeine on ductus contractility. To examine this hypothesis, we studied the effects of caffeine on the isolated preterm fetal sheep ductus arteriosus.
METHODSPreterm fetal lambs (mixed Western breed: 105 Ϯ 4 d of gestation, term ϭ 147) were delivered by cesarean section and anesthetized with keta...