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Published ahead of print on February 12, 2004, doi:10.1164/rccm.200309-1276OC

Am. J. Respir. Crit. Care Med., Volume 169, Number 9, May 2004, 1054-1062

A more recent version of this article appeared on May 1, 2004
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Submitted on September 17, 2003
Accepted on February 10, 2004

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

Merran A Thomson1, Bradley A Yoder2, Vicki T Winter3, Helen Martin4, Deborah Catland5, Theresa M Siler-Khodr6, and Jacqueline J Coalson7*

1 Division of Pediatrics, Hammersmith Hospital, London, United Kingdom, 2 Department of Medicine and Physiology, Southwest Foundation for Biomedical Research, San Antonio, TX, USA; Department of Pathology, University of Texas Health Science Center-San Antonio, San Antonio, TX, USA; Department of Pediatrics, University of Texas Health Science Center-San Antonio, San Antonio, TX, USA, 3 Department of Pathology, University of Texas Health Science Center-San Antonio, San Antonio, TX, USA, 4 Department of Medicine and Physiology, Southwest Foundation for Biomedical Research, San Antonio, TX, USA, 5 Department of Pathology, University of Texas Health Science Center-San Antonio, San Antonio, TX, USA; Pediatrix Medical Group, San Antonio, TX, USA, 6 Department of Obstetrics and Gynecology, University of Texas Health Science Center-San Antonio, San Antonio, TX, USA, 7 Department of Medicine and Physiology, Southwest Foundation for Biomedical Research, San Antonio, TX, USA; Department of Pathology, University of Texas Health Science Center-San Antonio, San Antonio, TX, USA

* To whom correspondence should be addressed. E-mail: coalson{at}uthscsa.edu.

Using the 125d baboon model of long term bronchopulmonary dysplasia (BPD), we hypothesized that early use of nasal continuous positive airway pressure (nCPAP), a non-invasive 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. Following delivery by cesarean section at 125-days (term=185days), the infants received 2 doses of CurosurfTM and daily caffeine citrate. Weaning from low volume-positive pressure ventilation (LV-PPV) to nCPAP was attempted at 24 hours age. Serial physiological parameters were recorded. Lung histopathology and morphometric measurements of nCPAP animals were done following necropsy at 28 days and data compared to 125-day 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 measurements were similar to 156-day gestational control lungs, the intrauterine developmental control. nCPAP is an effective non-invasive ventilatory technique that minimizes lung injury in baboons at risk of developing BPD.
Key words: alveolization, vasculogenesis, pneumonia, sepsis, cytokines




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