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. 2023 Oct 12;18(10):e0292671.
doi: 10.1371/journal.pone.0292671. eCollection 2023.

A pilot exploratory study examining the potential influence of continuous positive airway pressure devices on cranial molding trajectories in preterm infants

Dana B McCarty  1 , Ashley Hite  2 , Anna Brown  1 , Kerry Blazek  3 , Lauren Quinn  3 , Sara Hammond  3 , Marcella Boynton  4 , T Michael O'Shea  5
Affiliations

A pilot exploratory study examining the potential influence of continuous positive airway pressure devices on cranial molding trajectories in preterm infants

Dana B McCarty et al. PLoS One. .

Abstract

Objective: The objective of this exploratory study was to assess the potential impacts of two different continuous positive airway pressure (CPAP) devices on preterm infant head shape and circumference.

Study design: Twenty infants born at <32 weeks gestational age requiring CPAP support were enrolled. Ten infants used the Hudson RCI Nasal Prong CPAP device and 10 infants used the Fisher-Paykel CPAP device. Infant Cranial Index (CI) and head circumference (HC) were collected weekly as well as infant gestational age at birth, and total number of days on CPAP.

Results: At baseline, average total birthweight of infants was 1021 grams (SD = 227 grams), average gestational age was 26.9 weeks (SD = 1.80), mean CI was 79.7 cm (SD = 5.95), and HC was 10.2 cm (SD = 0.92). Days on CPAP ranged from 16 to 63 days, with an average of 40.7 (SD = 13.6) days. Neither CI nor HC differed by device type; however, the Fisher-Paykel device was associated with slightly greater HC growth rate.

Conclusion: CPAP devices and the pressures they apply plausibly contribute to preterm infant cranial molding over time, with the greatest potential impact on infants who require CPAP support for longer periods; however, these findings must be validated in larger cohorts. Additionally, positioning practices should be further examined to determine how they may contribute to or prevent the development of cranial molding deformity.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Hudson prong continuous positive airway pressure interface.
Fig 2
Fig 2. Fisher-Paykel continuous positive airway pressure interface.
A dolichocephalic head shape can be observed as the infant lies prone with head in full right rotation.
Fig 3
Fig 3
a. Estimated Cranial Index by Number of Days from Baseline Measurement. b. Estimated Head Circumference by Number of Days from Baseline Measurement.
Fig 4
Fig 4. Hypothesized head shape of infants wearing Hudson CPAP device.
The band illustrates the position of the fabric band that supplies attachment points for the CPAP interface. The left-pointing arrow indicates pressure created from the support surface of the mattress leading to a flattened posterolateral occiput from supine/semi-supine positioning. The upward-pointing arrow indicates superior protrusion of skull as the infant’s head grows in response to pressure from the circular band and posterolateral pressures from the support surface.
See this image and copyright information in PMC

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