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Published on: July 14, 2023
Home continuous positive airway pressure therapy in infants: a single-center experience
Shambhavi Sahotra Joshi1, Dasheni Sivapalan1, Marie-Josee Leclerc1
1Department of Respiratory and Sleep Medicine, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia.
Insights
Home continuous positive airway pressure (CPAP) therapy is effective for infants with sleep-disordered breathing. Many infants can be weaned off CPAP, even when started early in life.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Neonatology
Background:
- Limited data exist on home CPAP therapy for infants.
- Understanding indications and outcomes in this population is crucial.
Purpose of the Study:
- To analyze clinical, demographic, and polysomnographic characteristics of infants receiving home CPAP.
- To evaluate the effectiveness of CPAP for sleep-disordered breathing and respiratory support in the first year of life.
Main Methods:
- Retrospective evaluation of 29 infants initiated on home CPAP before one year of age.
- Data collected included diagnoses, respiratory support, surgical interventions, and polysomnography results.
Main Results:
- The median obstructive apnea-hypopnea index improved significantly with CPAP (14 to 3.4 events/h).
- Transcutaneous CO2 levels remained stable.
- Fifteen children required airway surgery, and 9 were successfully weaned from CPAP.
Conclusions:
- Home CPAP is an effective long-term respiratory support for infants.
- Infants can be weaned from CPAP even with early initiation.
- Further prospective studies are needed to define optimal CPAP initiation and cessation criteria.
Study Objectives:
There are limited data on indications and outcomes of home continuous positive airway pressure (CPAP) therapy in the first year of life. We aimed to analyze the clinical, demographic, and polysomnographic characteristics of a cohort of children initiated on home CPAP for treatment of sleep-disordered breathing and as respiratory support in the first year of life.
Methods:
Children started on CPAP in the first year of life at the Queensland Children's Hospital were retrospectively evaluated for clinical and demographic parameters, underlying diagnoses, respiratory support, airway surgical intervention, and polysomnography results at baseline and on CPAP.
Results:
Twenty-nine infants (median age [interquartile range] at CPAP initiation, 182 days [126-265.5 days]) were included. The underlying etiology included Trisomy 21 (n = 6), craniofacial syndromes (n = 5), hypotonia (n = 8; 5 with noncraniofacial syndrome), airway malacia (n = 5), skeletal dysplasia (n = 2), nonsyndromic upper airway obstruction (n = 2), and chronic neonatal lung disease (n = 1). The median (interquartile range) obstructive apnea-hypopnea index was 14 events/h (6.2-31 events/h) at CPAP initiation, which improved on CPAP to 3.4 events/h (1.4-6.4 events/h). The median (interquartile range) transcutaneous CO2 max remained unchanged on CPAP (56.6 mm Hg [49-66.5 mm Hg] pre-CPAP vs 54.9 mm Hg [47-62 mm Hg] on CPAP). Fifteen children needed surgical airway intervention (11 pre-CPAP and 4 post-CPAP). CPAP therapy could be successfully stopped in 9 children, 2 children needed tracheostomy, and 1 child died during the follow-up period.
Conclusions:
Home CPAP as respiratory support is an effective long-term therapy in infancy, and these patients can be weaned from CPAP therapy even if it was initiated early. Prospective studies with predefined criteria for CPAP initiation and cessation would help ascertain long-term outcomes in this poorly researched group.
Citation:
Joshi SS, Sivapalan D, Leclerc M-J, Kapur N. Home continuous positive airway pressure therapy in infants: a single-center experience. J Clin Sleep Med. 2023;19(3):473-477.
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