Jacob Sebastian, Wetzel Nancy, Bläser Annett, Thome Ulrich Herbert, Ascherl Rudolf Georg
Division of Neonatology, Department of Women's and Children's Health, University Hospital of Leipzig, Leipzig, Germany.
Department of Pediatrics, University Hospital of Halle-Wittenberg, Halle/Saale, Germany.
Front Pediatr. 2025 May 19;13:1514853. doi: 10.3389/fped.2025.1514853. eCollection 2025.
Continuous positive airway pressure (CPAP) devices for preterm infants are commonly affixed using snug-fitting caps. Monitoring of head growth is standard practice in preterm infants, as stagnant head growth has been associated with impaired neurodevelopmental outcome. However, a stagnant head circumference may not mean stagnant head growth since vertical head distortion has been repeatedly observed. Previously established centiles for ear-to-ear distances and head volume indices allow the evaluation of three-dimensional head growth. We hypothesized that CPAP duration may be associated with restricted head circumference gain, altered skull morphology, and possibly neurodevelopment.
All 4590 infants treated with CPAP in the neonatal wards of Leipzig University Medical Center between 2009 and 2020 were included in our study. Body weight, body length, occipitofrontal head circumference (OFC), and transvertical (vEED) and transfontanellar ear-to-ear (fEED) distances were measured repeatedly. Head eccentricity (ECC) (a measure of disproportional head growth) and head volume indices (HVI) were calculated. Anthropometric data were z-transformed. A total of 367 infants were followed up for assessment of neurodevelopmental outcomes using the Bayley Scales of Infant and Toddler Development (third edition). Associations between cumulative cap time and anthropometric data were examined using unconditional growth models with linear mixed effects. Associations between head growth development and neurodevelopmental outcome were examined by correlating individual regression slopes of anthropometric data with Bayley scores.
Cumulative cap time was negatively associated with z-scores of OFC ( , ), vEED ( , ], fEED ( , ), and HVI ( , ), while it was positively associated with ECC ( , ). Individual OFC z-score slopes show low correlation with cognition ( = 0.07), language ( = 0.06), and motor ( = 0.01) Bayley scores. Individual vEED z-scores slopes show low correlation with cognition ( = 0.10), language ( = 0.08), and motor ( = 0.07) Bayley scores.
CPAP caps are associated with vertical and horizontal head growth restriction and altered infant head morphology, as indicated by increasing eccentricity. The correlation of the altered growth pattern with neurodevelopmental outcome was negligible. Our findings have clinical implications for the assessment of head growth development during CPAP therapy.
早产儿持续气道正压通气（CPAP）设备通常使用贴合的帽子固定。监测早产儿的头围生长是标准做法，因为头围生长停滞与神经发育不良后果相关。然而，头围停滞并不一定意味着头部生长停滞，因为反复观察到垂直头型变形。先前建立的耳间距离和头容积指数百分位数可用于评估三维头部生长。我们假设CPAP使用时间可能与头围增长受限、颅骨形态改变以及可能的神经发育有关。
我们的研究纳入了2009年至2020年期间在莱比锡大学医学中心新生儿病房接受CPAP治疗的所有4590名婴儿。反复测量体重、身长、枕额头围（OFC）、经垂直（vEED）和经囟门耳间（fEED）距离。计算头部偏心率（ECC）（一种衡量头部生长不成比例的指标）和头容积指数（HVI）。人体测量数据进行z变换。共367名婴儿使用贝利婴幼儿发展量表（第三版）进行随访以评估神经发育结局。使用具有线性混合效应的无条件生长模型检查累计戴帽时间与人体测量数据之间的关联。通过将人体测量数据的个体回归斜率与贝利评分相关联来检查头部生长发育与神经发育结局之间的关联。
累计戴帽时间与OFC的z评分（ ， ）、vEED（ ， ]、fEED（ ， ）和HVI（ ， ）呈负相关，而与ECC呈正相关（ ， ）。个体OFC z评分斜率与认知（ = 0.07）、语言（ = 0.06）和运动（ = 0.01）贝利评分的相关性较低。个体vEED z评分斜率与认知（ = 0.10）、语言（ = 0.08）和运动（ = 0.07）贝利评分的相关性较低。
CPAP帽与头部垂直和水平生长受限以及婴儿头部形态改变有关，表现为偏心率增加。生长模式改变与神经发育结局的相关性可忽略不计。我们的研究结果对CPAP治疗期间头部生长发育的评估具有临床意义。
