Extending the use of a continuous positive airway pressure (CPAP) treatment in premature infants by two weeks significantly increases lung volume and lung diffusion capacity, according to a new study. The research will be presented at the Pediatric Academic Societies (PAS) 2024 Meeting, held May 3-6 in Toronto.
CPAP treatment is common for preterm infants with breathing issues, but researchers note there is no consensus on optimal treatment length when the preterm infant is doing well. Preterm birth is the most common cause of altered lung development and breathing issues that can last into adulthood, experts say.
“Extending CPAP treatment may be a simple and safe approach to improving preterm infant lung function and breathing in the absence of a lung growth therapy,” said Cindy T. McEvoy, MD, MCR, professor of pediatrics at Oregon Health & Science University and the presenting author. “The study’s findings solidify CPAP treatment as beneficial for preterm infants without requiring pharmaceuticals.”
In the study, researchers kept a group of preterm infants on CPAP treatment for an additional two weeks. The study found that patients who received the extra treatment had larger, healthier lungs six months later than those who did not.
Study authors say that the results can help clinicians determine an appropriate length of treatment.
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EDITOR:
Dr. Cindy McEvoy will present “Increased Alveolar Volume and Lung Diffusion Capacity in Former Preterm Infants Randomized to Two Extra Weeks of Continuous Positive Airway Pressure (CPAP) in the NICU” on Sunday, May 5 from 9:00-9:15 AM E.T.
Reporters interested in an interview with Dr. McEvoy should contact Amber Fraley at amber.fraley@pasmeeting.org.
The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. For more information, please visit www.pas-meeting.org.
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Abstract: Increased Alveolar Volume and Lung Diffusion Capacity in Former Preterm Infants Randomized to Two Extra Weeks of Continuous Positive Airway Pressure (CPAP) in the NICU
Presenting Author: Cindy T. McEvoy, MD, MCR
Organization: Oregon Health & Science University
Topic
Neonatal Clinical Trials
Background
There is no consensus regarding the optimal duration of CPAP in stable preterm infants. We have shown that stable preterm infants randomized to two extra weeks of CPAP (eCPAP) versus CPAP discontinuation (dCPAP; placed on room air, usual care at our NICU) had a significantly increased functional residual capacity (FRC) in the NICU at the end of treatment (NCT02249143; PMC7986570). However, the infants were not studied after discharge.
Objective
In our current trial (NCT04295564), we hypothesized that preterm infants meeting stability criteria for CPAP discontinuation but then randomized to two extra weeks of CPAP would have an increased alveolar volume (VA) and lung diffusion capacity (DLCO) at six months of age compared to those taken off CPAP in the NICU.
Design/Methods
Infants born at ≤ 32 weeks gestational age (GA) and requiring ≥ 24 hours of CPAP for clinical care were randomized to an extra two weeks of CPAP versus room air when meeting “CPAP stability criteria” (PMID: 22611116). Bubble CPAP was administered using Hudson prongs. Infants were stratified by GA at birth (< 28 versus ≥ 28 weeks). Twin pairs were assigned to the same treatment arm. Analysis was intention to treat. In the NICU, FRC was measured with the nitrogen washout technique at randomization and at the end of two weeks of treatment. At six months of corrected age, VA and DLCO were measured with the single breath hold technique as previously described (PMID16617450). The primary outcome was the difference in alveolar volume between the groups at six months of corrected age. Secondary outcomes included DLCO between the groups. We projected that 100 infants randomized would provide at least 76 infants with successful measurements of VA for an 80% power to show a 12% difference in VA. Outcome assessors were blinded to treatment allocation.
Results
100 infants were randomized. There was no difference in GA, birth weight, sex, or race between the groups. The eCPAP group had a significantly increased FRC compared to the dCPAP group at the end of the two-week treatment in the NICU. One infant was withdrawn after discharge due to the diagnosis of a rare congenital condition. 93 of 99 (46 in the dCPAP and 47 in the eCPAP randomized groups) had successful measurements of VA/DLCO at six months of age. (Table).
Conclusion(s)
Stable preterm infants randomized to eCPAP have a significantly increased VA and DLCO at about six months of age compared to those randomized to dCPAP. Since premature infants have impaired alveolarization and vascularization, an increased VA and DLCO may lead to improved infant respiratory health/improved lung function trajectory.
Tables and Images
Article Title
Increased Alveolar Volume and Lung Diffusion Capacity in Former Preterm Infants Randomized to Two Extra Weeks of Continuous Positive Airway Pressure (CPAP) in the NICU