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Extended Continuous Positive Airway Pressure in Preterm Infants Increases Lung Growth at 6 Months: A Randomized

Cindy T McEvoy1,2, Kelvin D MacDonald1, Mitzi A Go1

  • 1Department of Pediatrics.

American Journal of Respiratory and Critical Care Medicine
|February 20, 2025
PubMed

Insights

Extended continuous positive airway pressure (eCPAP) in the neonatal intensive care unit (NICU) improved lung growth in preterm infants. Two weeks of eCPAP was linked to greater alveolar volume and improved lung function at six months corrected age.

Area of Science:

  • Neonatal Medicine
  • Pediatric Pulmonology
  • Respiratory Physiology

Background:

  • Extended continuous positive airway pressure (eCPAP) is used in neonatal intensive care units (NICUs) for stable preterm infants to increase lung volumes.
  • The impact of eCPAP on lung growth after hospital discharge remains largely uninvestigated.

Purpose of the Study:

  • To determine if a two-week course of eCPAP in stable preterm infants is associated with enhanced alveolar volume (Va) at six months corrected age.
  • To evaluate secondary outcomes including diffusing capacity of the lungs for carbon monoxide (DlCO) and forced expiratory flows (FEFs).

Main Methods:

  • A randomized controlled trial was conducted at Oregon Health & Science University involving 100 preterm infants.
  • Infants were randomized to receive either eCPAP or discontinuation of CPAP (dCPAP) to room air, with outpatient assessors blinded to treatment allocation.
  • The primary outcome, Va, was measured using the single breath-hold technique at six months corrected age.

Main Results:

  • Infants receiving eCPAP demonstrated significantly increased Va (adjusted mean difference: 82.1 ml; P=0.033) compared to the dCPAP group.
  • Secondary outcomes also showed significant improvements in the eCPAP group, including DlCO (adjusted mean difference: 0.6 ml/min/mm Hg; P=0.018) and FEFs (P=0.039 and P=0.046).
  • Functional residual capacity (FRC) was measured in the NICU.

Conclusions:

  • A two-week course of eCPAP in stable preterm infants is associated with significantly increased alveolar volume at six months corrected age.
  • eCPAP therapy may serve as a safe, non-pharmacologic intervention to promote lung growth in preterm infants.
  • The study was registered at www.clinicaltrials.gov (NCT04295564).

Keywords:
airway functionalveolar volumelung diffusion capacitynasal continuous positive airway pressurepreterm infants

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