Am J Respir Crit Care Med. 2025 Feb 20. doi: 10.1164/rccm.202411-2169OC. Online ahead of print.
ABSTRACT
RATIONALE: Extended continuous positive airway pressure (eCPAP) in the neonatal intensive care unit (NICU) for stable preterm infants increases lung volumes. Its effect on lung growth after discharge is unknown.
OBJECTIVE: To assess whether 2-weeks of eCPAP in stable preterm infants is associated with increased alveolar volume (VA) at 6-months corrected age.
METHODS: Randomized controlled trial conducted at Oregon Health & Science University. Outpatient assessors unaware of treatment assignment. 100 infants randomized to eCPAP versus CPAP discontinuation (dCPAP) to room air.
MEASUREMENTS: The primary outcome was VA by the single breath hold technique at 6-months corrected age. Secondary outcomes included lung diffusion capacity to carbon monoxide (DL) and forced expiratory flows (FEFs). Functional residual capacity (FRC) was measured in the NICU.
MAIN RESULTS: Infants randomized to eCPAP (n=54) versus dCPAP (n=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% CI, 8.3-155.9]; p =0.033); DL (3.4 [0.2] vs 2.8 [0.1] mL/min/mmHg; adjusted mean difference, 0.6 [95% CI, 0.1-1.1]; p = 0.018); FEF50 (500.6 [18.2] vs 437.9 [17.9] mL/sec; adjusted mean difference, 62.7 [95% CI 4.5-121.0]; p = 0.039); FEF25-75 (452.0 [17.4] vs 394.4 [17.4] mL/sec; adjusted mean difference, 57.5 [95% CI 1.3-113.8]; p=0.046).
CONCLUSIONS: Infants randomized to eCPAP vs 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 non-pharmacologic and safe therapy to promote lung growth. Clinical trial registration available at www.
CLINICALTRIALS: gov, ID: NCT04295564.
PMID:39977011 | DOI:10.1164/rccm.202411-2169OC
