Summary
Extended continuous positive airway pressure (eCPAP) for stable preterm infants in the NICU significantly increases lung growth, alveolar volume, lung diffusion capacity, and airway function at 6 months corrected age compared to discontinuation of CPAP.
Highlights
- eCPAP in stable preterm infants increases alveolar volume at 6 months.
- Lung diffusion capacity (DLCO) is significantly improved with eCPAP.
- Forced expiratory flows (FEFs) show better airway function in eCPAP-treated infants.
- eCPAP leads to larger lung volumes in the NICU and after discharge.
- The study is a randomized controlled trial involving 100 preterm infants ≤32 weeks gestational age.
- eCPAP treatment duration was 2 weeks compared to discontinuation based on respiratory stability.
- No serious adverse events related to eCPAP were reported, confirming safety.
Key Insights
- Enhanced Lung Growth: Infants receiving extended CPAP exhibited a substantial increase in alveolar volume (VA), suggesting that prolonged CPAP supports lung development beyond initial NICU care.
- Improved Gas Exchange Capacity: The lung diffusion capacity (DLCO) measurements were higher in the eCPAP group, indicating better alveolar-capillary membrane function and potentially improved oxygen exchange.
- Better Airway Function: Increased forced expiratory flows (FEFs) in the eCPAP group demonstrate improved airway mechanics, which may reduce the long-term risk of respiratory complications such as wheezing or asthma.
- Sustained Benefits Post-Discharge: Lung growth improvements observed in the NICU persisted at least through 6 months corrected age, highlighting the lasting impact of extended CPAP treatment on lung development.
- Randomized Controlled Trial Rigor: The study’s robust design, with randomized allocation stratified by gestational age and twin pairing, enhances the validity and reliability of the observed outcomes.
- Feasibility and Safety: Despite some treatment failures requiring re-initiation of CPAP, eCPAP showed no serious adverse events related to treatment, supporting its clinical applicability.
- Clinical Implications: This evidence supports reconsidering CPAP duration protocols in preterm infant care to optimize lung growth and function, potentially reducing lifelong respiratory morbidity.
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Citation
McEvoy, C. T., MacDonald, K. D., Go, M. A., Milner, K., Harris, J., Schilling, D., … Tepper, R. S. (2025, April). Extended Continuous Positive Airway Pressure in Preterm Infants Increases Lung Growth at 6 Months: A Randomized Controlled Trial. American Journal of Respiratory and Critical Care Medicine. American Thoracic Society. http://doi.org/10.1164/rccm.202411-2169oc