Emerging Insights in Neonatal Care: Metabolic Impact of Extended CPAP in Preterm Infants

In a new study, extended CPAP demonstrated improved respiratory stability and somatic growth in preterm infants.

The randomized trial enrolled infants born at 24–32 weeks’ gestation (mean ≈30 weeks; mean birthweight ≈1,500 g) and compared two weeks of continued CPAP to discontinuation.

Primary endpoints included FRC and weight gain. The extended-CPAP arm showed a 2.1-fold FRC increase and a 1.13-fold (≈13%) greater weight gain by day 14. The study also incorporated metabolomic profiling across a 14-day window, providing prospectively measured physiologic and biochemical endpoints.

About 14% of 1,230 detected blood analytes differed between groups, with enrichment in acylcarnitines and bilirubin-degradation products among the most affected subpathways. Several metabolites correlated with the FRC and weight gains, a pattern consistent with reduced work of breathing and more efficient mitochondrial fatty-acid utilization as plausible physiologic mediators.

Caloric intake was similar between arms despite greater weight gain in the extended-CPAP group, and most metabolic shifts normalized within roughly one week after stopping CPAP.

Looking ahead, extended CPAP is a promising element of less-invasive ventilation strategies that may reduce work of breathing and support lung and somatic growth.