Preterm infants are currently supported with 5-8 cmH2O continuous positivie airway pressure (CPAP) at birth. This pressure range is predominantly extrapolated from CPAP support later on the... Show morePreterm infants are currently supported with 5-8 cmH2O continuous positivie airway pressure (CPAP) at birth. This pressure range is predominantly extrapolated from CPAP support later on the neonatal intensive care unit, while the underlying physiology during the transition at birth is considarably different. Based on literature- and retrospective studies, we hyptothesized that preterm infants may benefit from physiological-based (PB)-CPAP, wherein CPAP levels change following the pulmonary physiological changes during transition. PB-CPAP consists of an initial 15 cmH2O CPAP that promotes lung aeration, but that is later decreased to 8 cmH2O CPAP to maintain lung aeration. In animal studies, we demonstrated that PB-CPAP improves lung aeration and decreases the risk of apnea, without causing lung over-expansion when CPAP levels are decreased appropriately. In a randomized trial, we showed that PB-CPAP improves heart rates of preterm infants when compared to 5-8 cmH2O, which also implies improved lung aeration. Despite its benefits, the current PB-CPAP strategy is too complex for caregivers to combine with standard care. Future studies will focus on automatization or simplification of PB-CPAP to improve CPAP support for preterm infants at birth. Show less
