Extended Continuous Positive Airway Pressure in Infants Born Preterm Decreases Intermittent Hypoxemia: A Secondary Analysis of a Randomized Controlled Trial.

Abstract

To assess the impact of extended continuous positive airway pressure (eCPAP) vs discontinued continuous positive airway pressure (dCPAP) on intermittent hypoxemia (IH) episodes, IH duration, and mean pulse oximeter oxygen saturation (SpO₂) in stable infants born preterm. Prespecified secondary analysis of a single-center randomized trial. Infants ≤32 weeks' gestation who required ≥24 hours of continuous positive airway pressure and met predefined respiratory stability criteria on room air at <35 weeks postmenstrual age were randomized to 14 days of eCPAP or dCPAP. Continuous pulse oximetry was obtained using a high-resolution research oximeter (2-second sampling rate). Analyses were by intention to treat. Ninety-five of 100 randomized infants were included (50 eCPAP, 45 dCPAP). Infants randomized to eCPAP experienced significantly fewer IH episodes (SpO₂ <90% lasting 10-300 seconds) compared with dCPAP (mean 57.6 [SE 23.1] vs 151.7 [23.6]) for M_diff of -94.1(19.2) episodes per 24 hours, 95% CI [-132.2, -55.9], P < .0001). eCPAP was associated with a higher mean SpO₂ despite no supplemental oxygen use, fewer IH episodes across all thresholds and durations, and shorter cumulative IH duration. Functional residual capacity at the end of treatment was significantly higher in the eCPAP group and inversely correlated with IH burden (r = -0.32, P = .0016). Mediation analysis demonstrated that 66.3% of the treatment effect of eCPAP on IH reduction was mediated through increased SpO₂. In stable preterm infants breathing room air, extending continuous positive airway pressure therapy significantly reduces the frequency and duration of IH and increases mean oxygenation. eCPAP is a simple, nonpharmacologic strategy to mitigate IH during a critical period of lung and brain development. ClinicalTrials.gov NCT04295564.