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Treatment of Immature Baboons for 28 Days with Early Nasal Continuous Positive Airway Pressure

Division of Paedatrics, Hammersmith Hospital, London, United Kingdom; Department of Medicine and Physiology, Southwest Foundation for Biomedical Research; Departments of Pathology, Pediatrics, and Obstetrics and Gynecology, University of Texas Health Science Center-San Antonio; and Pediatrix Medical Group, San Antonio, Texas

Correspondence and requests for reprints should be addressed to Jacqueline J. Coalson, Ph.D., Department of Pathology, 7703 Floyd Curl Drive, UTHSCSA, San Antonio, TX 78229. E-mail: coalson{at}uthscsa.edu

Using the 125-day baboon model of long-term bronchopulmonary dysplasia, we hypothesized that early use of nasal continuous positive airway pressure (nCPAP), a noninvasive ventilatory method, combined with prophylactic surfactant therapy would permit continuation of alveolar and vascular development in the lung. Retrospective human studies have shown that infants treated with nCPAP spend less time on mechanical ventilation and thereby sustain less volutrauma. After delivery by cesarean section at 125 days (term, 185 days), the infants received two doses of surfactant (Curosurf) and daily caffeine citrate. Weaning from low-volume positive pressure ventilation to nCPAP was attempted at 24 hours of age. Serial physiological parameters were recorded. Lung histopathology and morphometric measurements of nCPAP animals were done after necropsy at 28 days and data were compared with 125- and 156-day gestational controls. Documented episodes of clinical sepsis and pneumonia at postmortem examination were absent. nCPAP lungs showed enlarged thin-walled air spaces with minimal fibroproliferation and scattered secondary crests. Internal surface area and surface-to-volume ratio dimensions were similar to those of 156-day gestational control lungs, the intrauterine developmental control. nCPAP is an effective noninvasive ventilatory technique that minimizes lung injury in baboons at risk of developing bronchopulmonary dysplasia.

Key Words: alveolarization • cytokines • pneumonia • sepsis • vasculogenesis

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