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Transient Dip in Head Circumference Growth Trajectories Associated With Continuous Positive Airway Pressure

Elena-Laura Dumitrescu1, Christoph Bührer1

  • 1Department of Neonatology, Charité Universitätsmedizin Berlin, Berlin, Germany.

Acta Paediatrica (Oslo, Norway : 1992)
|December 5, 2025
PubMed

Insights

Continuous positive airway pressure (CPAP) in preterm infants is linked to a temporary drop in head circumference percentiles. Recovery of head circumference percentiles was observed after CPAP discontinuation.

Area of Science:

  • Neonatalogy
  • Pediatric Neurology
  • Medical Devices

Background:

  • Decreasing head circumference (HC) percentiles in preterm infants correlate with neurodevelopmental impairments.
  • Respiratory support devices, such as continuous positive airway pressure (CPAP), may influence infant skull morphology.

Purpose of the Study:

  • To investigate the impact of sequentially administered CPAP and high-flow nasal cannula (HFNC) on HC percentiles in preterm infants.
  • To analyze changes in HC percentiles during and after CPAP use.

Main Methods:

  • Retrospective study of preterm infants (<1500g birthweight, <30 weeks gestational age) born between 2019-2020.
  • Exclusion criteria included syndromes and severe intraventricular hemorrhage (grade ≥2).
  • Routine HC measurements were converted to percentiles and compared at birth, during CPAP, after CPAP weaning, and at discharge.

Main Results:

  • A significant drop in HC percentiles was observed after CPAP initiation (57 to 16, p<0.001).
  • HC percentiles further declined when CPAP was partially replaced by HFNC (to 7, p<0.001).
  • HC percentiles gradually increased after CPAP discontinuation, reaching 22 by discharge (p<0.001).

Conclusions:

  • CPAP use in preterm infants is associated with a transient decrease in HC percentiles.
  • HC percentiles showed a gradual recovery following the discontinuation of CPAP.
Abstract

Keywords:
continuous positive airway pressurehead circumferencenoninvasive respiratory supporttrajectoriesvery preterm infants

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