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

• Published in: American journal of respiratory and critical care medicine Vol. 211; no. 4; pp. 610 - 618
• Main Authors: McEvoy, Cindy T., MacDonald, Kelvin D., Go, Mitzi A., Milner, Kristin, Harris, Julia, Schilling, Diane, Olson, Matthew, Tiller, Christina, Slaven, James E., Bjerregaard, Jeffrey, Vu, Annette, Martin, Alec, Mamidi, Rachna, Schelonka, Robert L., Morris, Cynthia D., Tepper, Robert S.
• Format: Journal Article
• Language: English
• Published: United States American Thoracic Society 01.04.2025
• Subjects: Continuous positive airway pressure; Continuous Positive Airway Pressure - methods; Female; Humans; Infant; Infant, Newborn; Infant, Premature - growth & development; Intensive care; Intensive Care Units, Neonatal; Lung - growth & development; Male; Medical treatment; Neonatal care; Original; Premature babies; Treatment Outcome; airway function; alveolar volume; lung diffusion capacity; preterm infants; nasal continuous positive airway pressure
• ISSN: 1073-449X; 1535-4970; 1535-4970
• DOI: 10.1164/rccm.202411-2169OC

Extended continuous positive airway pressure (eCPAP) in the neonatal ICU (NICU) for stable preterm infants increases lung volumes. Its effect on lung growth after discharge is unknown. To assess whether 2 weeks of eCPAP in stable preterm infants is associated with increased alveolar volume (Va) at 6 months corrected age. This randomized controlled trial was conducted at Oregon Health & Science University. Outpatient assessors were unaware of treatment assignment. One hundred infants were randomized to eCPAP versus CPAP discontinuation (dCPAP) to room air. The primary outcome was Va by the single breath hold technique at 6 months corrected age. Secondary outcomes included Dl and forced expiratory flows (FEFs). FRC was measured in the NICU. Infants randomized to eCPAP (  = 54) versus dCPAP (  = 46) had the following measurements shown as adjusted mean (SE): Va (500.2 [24.9] vs. 418.1 [23.4] ml; adjusted mean difference, 82.1 [95% confidence interval (CI), 8.3-155.9];  = 0.033); Dl (3.4 [0.2] vs. 2.8 [0.1] ml/min/mm Hg; adjusted mean difference, 0.6 [95% CI, 0.1-1.1];  = 0.018); measurement of FEF at 50% of the expired volume (500.6 [18.2] vs. 437.9 [17.9] ml/s; adjusted mean difference, 62.7 [95% CI, 4.5-121.0];  = 0.039); FEF between 25% and 75% of expired volume (452.0 [17.4] vs. 394.4 [17.4] ml/s; adjusted mean difference, 57.5 [95% CI, 1.3-113.8];  = 0.046). Infants randomized to eCPAP versus dCPAP had significantly increased Va at 6 months corrected age. Dl and FEFs were also increased. Extending CPAP in stable preterm infants in the NICU may be a nonpharmacologic and safe therapy to promote lung growth. Clinical trial registered with www.clinicaltrials.gov (NCT04295564).