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Recent research from Oregon Health & Science University (OHSU) indicates that extending the use of continuous positive airway pressure (CPAP) for preterm infants in hospital settings can significantly enhance lung growth and functionality.
Published in the American Journal of Respiratory and Critical Care Medicine, the study demonstrates that prolonging CPAP support beyond the currently standard duration observed in clinical practice can lead to improved development of the lungs in premature infants.
According to physician-scientists at OHSU, utilizing this widely available respiratory support tool in neonatal intensive care units (NICUs) may contribute to healthier respiratory development as these children grow.
Approximately 10% of births in the United States are preterm, equating to around 400,000 infants annually. Premature birth is the leading cause of abnormalities in lung development, potentially resulting in lifelong respiratory issues. Infants who are born preterm face heightened risks of conditions like wheezing, asthma, and hospitalizations due to respiratory illnesses compared to their full-term peers. Moreover, impairments in airway function during infancy can persist into adulthood, leading to increased respiratory complications.
While the current standard of care mandates the early application of CPAP for infants facing respiratory distress, there is no consensus on the ideal duration of this intervention. Typically, NICUs discontinue CPAP as soon as an infant appears stable without evident breathing difficulties.
This study is pioneering in its approach, setting new benchmarks for the treatment by exploring how prolonged CPAP usage influences lung growth in preterm infants.
“Reduced lung function in early life frequently corresponds with persistent low lung capacity into adulthood, making it essential to identify early interventions to mitigate these risks,” stated Dr. Cindy McEvoy, the principal investigator and a professor of pediatrics at the OHSU School of Medicine and OHSU Doernbecher Children’s Hospital. “Our results imply that minor adjustments to the existing CPAP protocol in NICUs could provide a safe, non-drug method for enhancing a child’s future lung function and respiratory health. We are optimistic that extending the duration of CPAP can be a straightforward intervention adopted globally.”
In a randomized controlled trial involving 100 preterm infants, researchers at OHSU observed that stable preterm infants who received an additional two weeks of CPAP treatment exhibited significantly improved lung volumes—a critical metric for assessing lung growth—when evaluated at six months post-NICU discharge.
The findings revealed that the lungs of these infants were more efficient in diffusing oxygen and carbon dioxide, accompanied by indications of improved airway functionality. Notably, follow-up assessments at 12 months showed reduced instances of wheezing in infants who had undergone the extended CPAP treatment.
As a result of these promising findings, OHSU Doernbecher Children’s Hospital has initiated the practice of extending CPAP usage for preterm infants in its NICU, witnessing encouraging outcomes thus far. Other NICUs across the nation are also reassessing their CPAP protocols in light of this research.
Looking ahead, researchers emphasize the necessity for additional studies to determine the optimal duration of CPAP treatment for preterm infants, particularly among those with very low birth weights. Moreover, long-term follow-up is essential to ascertain if this treatment strategy could enhance the respiratory health of children born preterm in the years to come, potentially offering protection against prevalent lung diseases like asthma and chronic obstructive pulmonary disease in adulthood.
Dr. McEvoy’s research team intends to monitor the participants from the randomized trial through age 10, conducting annual lung function tests to evaluate the lasting effects of extended CPAP treatment initiated in the NICU.
“CPAP is a standard tool available in every NICU, which makes it a readily implementable intervention,” observed Dr. Dmitry Dukhovny, professor of pediatrics and medical director of the NICU at OHSU Doernbecher Children’s Hospital. “Our aim is to ensure children receive the best foundation for a healthy and fulfilling life, and it’s encouraging to see that we can significantly enhance lung growth and function in preterm infants simply by adjusting the duration of a routine treatment.”
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