Home continuous positive airway pressure therapy in infants: a single center experience.

STUDY OBJECTIVES
There is limited data on indications and outcomes of home continuous positive airway pressure (CPAP) therapy in the first year of life. We aimed to analyze the clinical, demographic, and polysomnographic (PSG) characteristics of a cohort of children initiated on home CPAP for treatment of sleep disordered breathing (SDB) and as respiratory support in the first year of life.


METHODS
Children started on CPAP in the first year of life at the Queensland Children's Hospital were retrospectively evaluated for clinical & demographic parameters, underlying diagnoses, respiratory support, airway surgical intervention, PSG results at baseline and on CPAP.


RESULTS
Twenty-nine infants [median age (IQR) at CPAP initiation 182 days (126-265.5); 12F] were included. Underlying aetiology included Trisomy 21 (n=6), craniofacial syndromes (n=5), hypotonia (n=8; 5 with non-craniofacial syndrome), airway malacia (n=5), skeletal dysplasia (n=2), non-syndromic upper airway obstruction (n=2) and CNLD (n=1). The median (IQR) Obstructive Apnoea-Hypopnea Index was 14\hr (6.2-31) at CPAP initiation, which improved on CPAP to 3.4\hr (1.4-6.4). Median (IQR) TcCO2 max remained unchanged on CPAP [56.6 mmHg (49-66.5 mmHg) pre-CPAP vs. 54.9 mmHg (47-62mmHg) on CPAP]. 15 children needed surgical airway intervention (11 pre and 4 post CPAP). CPAP therapy could be successfully ceased in 9 children, 2 needed tracheostomy and 1 child died during follow-up period.


CONCLUSIONS
Home CPAP as respiratory support is an effective long-term therapy in infancy and can be weaned even if initiated early. Prospective studies with pre-defined criteria for CPAP initiation and cessation would help ascertain long term outcomes in this poorly researched group.