Does Keeping Premature Babies on Caffeine Help Them Come Home Sooner?

A large U.S. study, the MoCHA trial, tested whether continuing a common breathing medicine speeds up discharge — and what its answer means for families

A large U.S. study found that keeping moderately premature babies on caffeine — a standard medicine for the pauses in breathing common in preemies — did not get them home from the hospital any sooner than stopping it. Babies on continued caffeine had slightly fewer breathing pauses but were discharged at the same age, while having more episodes of a fast heartbeat. The findings reassure families that stopping caffeine on schedule is safe and does not lead to more readmissions.

Why This Question Matters

If you have spent time in a neonatal intensive care unit (NICU), you have almost certainly heard about caffeine. It is one of the most widely used medicines in newborn care. Premature babies often have apnea of prematurity — short pauses in breathing that happen because the part of the brain that controls breathing is still maturing [1]. Caffeine gently stimulates that breathing control, and decades ago a landmark trial showed it not only reduces these pauses but also protects babies' lungs and early development [2][3]. Because of that, nearly every premature baby receives it.

For most families, one of the hardest parts of the NICU journey is simply not knowing when their baby will come home. Apnea is one of the main reasons a discharge gets delayed: babies usually cannot go home until their breathing pauses have stopped. This study asked a very practical question that touches every NICU family — if doctors keep a baby on caffeine longer, instead of stopping it on the usual schedule, will the baby get home faster? [4]

How Families and Doctors Have Faced This Until Now

For years, doctors faced a frustrating uncertainty. They knew when to start caffeine, but had almost no solid evidence about when to stop it. Caffeine lingers in a baby's body for several days after the last dose, so even after the medicine is stopped, it keeps working for a while and can hide whether a baby's breathing is truly mature. To be safe, most hospitals watch a baby for about 5 to 10 days after stopping caffeine before deciding the apnea has resolved and sending the family home [1]. Those extra watch-and-wait days in the hospital add up.

With no clear rulebook, practice varied enormously from hospital to hospital. One study that looked at more than 81,000 babies across 304 NICUs found that the typical age at which caffeine was stopped ranged widely between units — and, surprisingly, hospitals that kept babies on caffeine longer often sent them home earlier, not later [5]. Some smaller studies hinted that staying on caffeine might reduce brief dips in oxygen as babies approached their due date [6]. A 2024 review of the evidence concluded that the existing studies were too small to settle the matter and called for a larger, more rigorous trial [7]. That trial is the one described here.

What the Study Did

The study was called MoCHA, which stands for Moderately preterm infants with Caffeine at Home for Apnea [4]. Researchers enrolled 827 babies at 29 hospitals in a respected U.S. research network. The babies were all born between 29 and 33 weeks of pregnancy and, by the time they joined, were doing well: breathing room air on their own, feeding fully, and ready to have their caffeine stopped.

Instead of simply stopping the caffeine, the researchers used a careful coin-flip method to assign each baby to one of two groups. Half kept taking caffeine, and half received a placebo — a look-alike liquid with no medicine in it. Neither the families nor the bedside doctors and nurses knew which baby got which, so expectations could not color the results. The babies stayed on their assigned drink daily until they went home and for 28 days afterward. If a doctor ever felt a baby genuinely needed caffeine for breathing pauses, they were free to give it openly — so no baby was left without treatment if it was truly needed. The main thing the researchers measured was simple and meaningful: how many days until the baby went home.

What They Found

Continuing caffeine did not get babies home any sooner. Babies on caffeine went home a median of 18 days after joining the study, and babies on placebo went home at 16.5 days — a difference of essentially zero [4]. The age at which they were discharged was the same in both groups, and so was the time it took to reach full feeding and overall readiness. The study was actually stopped a little early because it had become clear that caffeine was not going to make a difference to discharge — not because anything harmful was happening.

The medicine did do what it is known to do. Babies on caffeine stopped having breathing pauses a bit sooner and were less likely to have a significant pause during the study [4]. But fewer breathing pauses did not translate into an earlier trip home. That is because, for these relatively mature babies, going home depends on several things coming together — feeding well by mouth, holding their temperature steady, and each hospital's own discharge routine — not just on breathing.

There was reassuring news for the period after discharge: babies in both groups were equally likely to be readmitted or to need a sick visit for breathing concerns [4]. On the other side of the ledger, babies on caffeine more often had episodes of a fast heartbeat (about 9% versus 4%) and gained weight slightly more slowly. One baby in the caffeine group died and none in the placebo group, and the overall number of medical problems was similar between the groups.

What This Means for Your Baby

If your baby is moderately premature, stable, and feeding well, this study offers genuine peace of mind. Stopping caffeine on the usual schedule is safe, and keeping your baby on it longer would not bring the homecoming forward — it would only add a small risk of a fast heartbeat and slightly slower weight gain, with no benefit in return [4]. It also means that if your baby's caffeine is stopped and they go home as planned, they are not at greater risk of being readmitted for breathing problems. Apnea of prematurity is, for these babies, a normal stage they outgrow as they mature [1].

It is worth knowing that these findings apply to moderately premature, healthy babies near discharge — not to the smallest, most fragile infants, for whom caffeine plays a different and very important role [8]. Caffeine remains one of the most valuable medicines in newborn care [2], and long-term follow-up of the original landmark trial found that children who had received it were doing well years later [9]. This study simply answers one specific question: stretching it out longer is not a shortcut home.

It may also help to know what to expect around the time caffeine is stopped. Because the medicine stays active in your baby's system for several days, the care team will usually keep an eye on your baby's breathing for a stretch of days after the last dose before confirming that the pauses have truly resolved. That waiting period is a normal, cautious part of the process — not a sign that something is wrong. If you ever feel unsure, it is completely reasonable to ask your team questions such as: Is my baby ready to stop caffeine? What will you be watching for afterward? And what should I look out for once we are home? In this study, the babies whose caffeine was continued did experience a fast heartbeat more often and put on weight a little more slowly, which is part of why simply leaving a baby on caffeine without a clear reason is not harmless or helpful [4]. The reassuring bottom line is that a baby who is breathing well on their own, feeding fully, and otherwise ready does not need the medicine stretched out to be safe at home.

What Researchers Are Working On Next

The biggest lesson is that the path home may depend less on the breathing medicine and more on the days hospitals spend watching and waiting, and on how quickly babies learn to feed [5]. Researchers now want to learn whether that watch-and-wait period can be safely shortened, and whether any group of babies benefits from staying on caffeine a little longer — ideally using small monitors that can track breathing at home [6][10]. It can also be comforting to understand why fewer breathing pauses did not equal an earlier homecoming. Coming home is not a single switch; it depends on several abilities arriving together — feeding fully and safely by mouth, keeping warm in an open crib, and growing steadily — and these develop on the baby's own schedule as they mature. Caffeine can quiet the breathing pauses, but it cannot rush the deeper process of growing up that readiness really depends on. For families, the takeaway today is simple and hopeful: when the team decides it is time to stop caffeine, that decision is well grounded, and your baby's homecoming is being guided by good evidence.

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  4. Carlo WA, Eichenwald EC, Carper BA, et al. Extended Caffeine for Apnea in Moderately Preterm Infants: The MoCHA Randomized Clinical Trial. JAMA. 2025;333(24):2154–2163. doi:10.1001/jama.2025.5791 ↩
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  8. Dobson NR, Patel RM, Smith PB, et al. Trends in caffeine use and association between clinical outcomes and timing of therapy in very low birth weight infants. J Pediatr. 2014;164(5):992–998. doi:10.1016/j.jpeds.2013.12.025 ↩
  9. Schmidt B, Anderson PJ, Doyle LW, et al. Survival without disability to age 5 years after neonatal caffeine therapy for apnea of prematurity. JAMA. 2012;307(3):275–282. doi:10.1001/jama.2011.2024 ↩
  10. Oliphant EA, Hanning SM, McKinlay CJD, Alsweiler JM. Caffeine for apnea and prevention of neurodevelopmental impairment in preterm infants: systematic review and meta-analysis. J Perinatol. 2024;44(6):785–801. doi:10.1038/s41372-024-01939-x ↩