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Nasal CPAP increases alveolar number in a rhesus monkey model of moderate prematurity
Cindy T McEvoy1, Kelvin D MacDonald1, Lyndsey E Shorey-Kendrick2
1Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA.
Insights
Nasal continuous positive airway pressure (nCPAP) in moderate to late preterm (MLP) infants promotes alveolar development. This study in a rhesus monkey model showed nCPAP increased alveoli numbers, suggesting potential benefits for infant respiratory health.
Area of Science:
- Neonatal physiology
- Respiratory medicine
- Developmental biology
Background:
- Moderate to late preterm (MLP) infants often experience respiratory issues.
- Mechanical lung distention may enhance lung growth and alveolar development.
- The effect of nCPAP on MLP infant lung development requires investigation.
Purpose of the Study:
- To investigate the impact of nasal continuous positive airway pressure (nCPAP) on lung development in moderate to late preterm (MLP) infants.
- To establish a rhesus monkey model for studying nCPAP effects on prematurity-related lung changes.
Main Methods:
- Rhesus monkey fetuses were delivered at 85% gestation (equivalent to 32-34 weeks).
- Infants received either nCPAP or sham nCPAP for 9 days, 12 hours daily.
- Pulmonary function tests and necropsy for lung structural and gene expression analysis were performed.
Main Results:
- nCPAP treatment led to a significant increase in alveoli numbers compared to the sham group.
- Functional and anatomical changes indicated enhanced alveolarisation in the nCPAP group.
- Gene expression profiles were similar between nCPAP and sham groups, but distinct from controls.
Conclusions:
- nCPAP administration in MLP infants stimulates alveolarisation.
- This intervention shows minimal other structural or functional changes.
- Further research is needed to determine the long-term respiratory health benefits for infants.
Background:
Most premature human infants are born in the moderate to late preterm (MLP) range, ≥30 to <37 weeks gestation, and demonstrate increased incidence of wheeze and respiratory illness as they age. Animal models suggest that mechanical lung distention stimulates lung growth and alveolar development. To determine if nasal continuous positive airway pressure (nCPAP) influences MLP infant lung development, we developed a rhesus monkey model of moderate prematurity, randomised to 9 days of nCPAP or sham nCPAP.
Methods:
Timed-pregnant fetuses were delivered by elective hysterotomy at gestational age (GA) 140±1 days (85% gestation; term=165 days; human equivalent of 32-34 weeks) or at GA-149±1 days as a relative gestational age reference (GA-control). The day after delivery, the GA-140 animals were treated with nCPAP or sham nCPAP for 9 days, 12 consecutive hours each day. Pulmonary function testing followed by necropsy for analysis of lung structure and gene expression was performed on the equivalent of GA-150 for all animals.
Results:
The nCPAP and sham groups were clinically similar but distinct from the GA-control group. Stereological analysis of lung structure showed significantly increased numbers of alveoli in the nCPAP group compared to the sham group. Other functional and anatomical changes were consistent with increased alveolarisation. Gene expression between the nCPAP and sham groups remained highly similar and distinct from GA-control animals.
Conclusions:
We show that nCPAP in MLP infants stimulates alveolarisation with relatively few other changes. How this may benefit subsequent infant respiratory health requires further study.
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