# Transient Dip in Head Circumference Growth Trajectories Associated With Continuous Positive Airway Pressure Administration in Very Preterm Infants

## TL;DR

Using CPAP in very preterm infants temporarily lowers head circumference growth, but it recovers after stopping the treatment.

## Contribution

Shows that CPAP causes a temporary drop in head growth in preterm infants, which recovers after discontinuation.

## Key findings

- CPAP initiation caused a significant drop in head circumference percentiles.
- Percentiles gradually recovered after CPAP was discontinued.
- Head circumference continued to improve until hospital discharge.

## Abstract

In preterm infants, decreasing head circumference (HC) percentiles have been linked to neurodevelopmental impairment. Devices for administering continuous positive airway pressure (CPAP) may alter skull morphology. We investigated the impact of sequentially administered CPAP and high‐flow nasal cannula on HC percentiles.

In this retrospective single‐institution study of infants < 1500 g birthweight and < 30 weeks gestational age born 2019–2020 (syndromes and intraventricular haemorrhage ≥ grade 2 excluded), routine HC measurements were translated into HC percentiles. We compared data at birth, after CPAP initiation, after partial and complete discontinuation of CPAP, and at discharge.

The study included 137 infants (median [interquartile range] gestational age 27+3 [25+5–28+6] weeks, birthweight 890 [715–1120] g). After initiation of CPAP, HC percentiles dropped from 57 [18–77] to 16 [2–26] (p < 0.001), and declined further until CPAP was partially replaced by high‐flow nasal cannula to 7 [3–30] (p < 0.001). HC percentiles increased after total weaning off CPAP to 14 [3–30] (p = 0.004) and continued to rise until discharge to 22 [8–37] (p < 0.001).

CPAP was associated with a transient decline of HC percentiles, with gradual recovery after CPAP discontinuation.

At birth, skull sutures are partly open to allow for adaptation of the infant's head to external forces.In very preterm infants, prolonged administration of continuous positive airway pressure (CPAP) was associated with a transient decline of occipitofrontal head circumference percentiles and z scores.Head circumference percentiles and z scores showed gradual recovery after CPAP discontinuation.

At birth, skull sutures are partly open to allow for adaptation of the infant's head to external forces.

In very preterm infants, prolonged administration of continuous positive airway pressure (CPAP) was associated with a transient decline of occipitofrontal head circumference percentiles and z scores.

Head circumference percentiles and z scores showed gradual recovery after CPAP discontinuation.