Extended Continuous Positive Airway Pressure in Preterm Infants Increases Lung Growth at 6 Months: A Randomized Controlled Trial

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. To assess whether 2-weeks of eCPAP in stable preterm infants is associated with increased alveolar volume (VA) at 6-months corrected age. 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. 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. 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). 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. gov, ID: NCT04295564.