In a groundbreaking advancement in neonatal care, researchers at Oregon Health & Science University have demonstrated that extending the duration of continuous positive airway pressure (CPAP) therapy for preterm infants can significantly enhance lung growth and function. This paradigm-shifting discovery, published in the prestigious American Journal of Respiratory and Critical Care Medicine, challenges existing clinical conventions and offers profound implications for the respiratory health trajectory of millions of children born prematurely each year.
Preterm birth, defined as delivery before 37 weeks of gestation, complicates approximately 10% of births in the United States, equating to about 400,000 affected infants annually. This early arrival into the world disrupts normal pulmonary development, often resulting in compromised lung architecture that may predispose survivors to chronic respiratory difficulties. Among these are increased risks for wheezing, asthma, and recurrent hospitalizations due to respiratory illnesses, conditions that may persist well into adulthood and severely diminish quality of life. Existing therapies focus primarily on stabilizing respiratory distress immediately following birth, yet the optimal duration of such interventions—particularly CPAP—remains a contentious matter in neonatology.
CPAP, a noninvasive respiratory support technique that maintains positive airway pressure through nasal prongs or masks, has become standard practice for managing respiratory distress in neonates. While early initiation of CPAP is universally accepted, clinicians typically discontinue its use once overt breathing difficulties resolve. The OHSU research team sought to interrogate whether prolonging CPAP therapy beyond this point could foster improved lung maturation, hypothesizing that mechanical support aids alveolar development and enhances gas exchange capabilities in immature lungs.
Conducting a meticulously designed randomized controlled trial involving 100 stable preterm infants, the scientists extended the CPAP treatment by two additional weeks beyond standard care intervals. By doing so, they observed remarkable enhancements in several key pulmonary metrics. At a six-month follow-up post-discharge, infants who received extended CPAP exhibited significantly greater lung volumes, an established biomarker of improved lung growth and functional capacity. Moreover, these infants demonstrated superior oxygen and carbon dioxide diffusion efficiency, underscoring improved alveolar-capillary membrane integrity and pulmonary microstructure.
The study further revealed that infants treated with prolonged CPAP experienced fewer wheezing episodes during their first year, suggesting a durable protective effect against airway hyperreactivity and inflammation that commonly affect this vulnerable population. These findings imply that a relatively simple alteration in therapeutic duration can impart substantial benefits that extend well beyond the immediate neonatal period, potentially mitigating the risk of chronic respiratory disease in later life.
Importantly, the therapy evaluated is both accessible and readily implementable across NICUs globally. CPAP devices are standard equipment, requiring no novel pharmacological agents or invasive procedures, thereby offering a low-cost, scalable intervention. The OHSU Doernbecher Children’s Hospital has already adopted this extended CPAP protocol, reporting ongoing positive outcomes in their patient cohort. Several other NICUs nationwide are currently revisiting their CPAP management strategies in light of these compelling results.
Despite these promising revelations, the researchers caution that further studies are essential to delineate the optimal CPAP duration for varied strata within the preterm infant population. Infants with very low birth weights or additional co-morbidities may require tailored approaches, and longitudinal data are crucial to ascertain sustained respiratory benefits or potential unforeseen consequences. To that end, the investigative team plans to monitor the original trial cohort through age 10, employing annual lung function assessments to parse the long-term impact of extended CPAP therapy on pulmonary health trajectories.
Mechanistically, the findings align with emerging insights into lung developmental biology. The preterm lung is characterized by arrested alveolarization and reduced surface area for gas exchange. By providing a sustained distending pressure, CPAP may prevent atelectasis, maintain airway patency, and promote optimal mechanical stretch-induced signaling pathways pivotal for alveolar septation and vascularization. This mechanotransduction is vital for establishing robust, functional lung architecture capable of efficient respiration.
From a clinical standpoint, this research reframes our understanding of neonatal respiratory management, emphasizing that timing and duration of interventions are as critical as their presence. Extending CPAP therapy represents a nonpharmacological strategy that is safe, efficient, and capable of modifying the natural history of lung disease in preterm infants. Such interventions may ultimately reduce the burden of chronic respiratory ailments, health care costs, and improve life quality for patients born prematurely.
Dr. Cindy McEvoy, the principal investigator and a professor of pediatrics at OHSU’s School of Medicine, highlights the transformative potential of this work. She states, “Adjusting the duration of CPAP application offers a safe and actionable method to influence lung development positively. Our aim is to ensure these infants have the best possible respiratory outcomes throughout their lives.” Her statement underscores a shift towards proactive optimization of neonatal treatments beyond immediate survival, targeting lifelong health outcomes.
Dr. Dmitry Dukhovny, medical director of the NICU at OHSU Doernbecher Children’s Hospital, further emphasizes the accessibility of this intervention, noting its ubiquity in NICUs and ease of implementation. “By simply modifying how long we administer CPAP, we can profoundly impact lung function development. This study exemplifies how small changes in clinical practice can have outsized benefits,” he notes.
In summation, the OHSU study substantiates that prolonged CPAP administration in stable preterm infants results in enhanced lung growth, improved pulmonary gas exchange, and reduced respiratory morbidity during infancy. It heralds a new era in neonatal respiratory care, where treatment duration is intelligently tailored to optimize developmental outcomes. The broader neonatal community is poised to embrace these findings, with ongoing trials and longitudinal investigations anticipated to solidify extended CPAP as a new standard of care.
Subject of Research: Extended continuous positive airway pressure therapy and its effects on lung growth and function in preterm infants.
Article Title: Extended Continuous Positive Airway Pressure in Preterm Infants Increases Lung Growth at 6 Months: A Randomized Controlled Trial
Web References:
https://www.atsjournals.org/doi/10.1164/rccm.202411-2169OC
https://www.ohsu.edu/doernbecher/neonatal-intensive-care-unit-nicu
References:
- McEvoy, C. et al. (2024). 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. DOI: 10.1164/rccm.202411-2169OC
Keywords: Infants, Lungs, Respiration, Disease intervention, Clinical research
