Characterizing Continuous Positive Airway Pressure (CPAP) Belly Syndrome in Preterm Infants in the Neonatal Intensive Care Unit (NICU)

Objective: To reproducibly define CPAP Belly Syndrome (CBS) in preterm infants and describe associated demographic characteristics, mechanical factors, and outcomes. Study Design : A retrospective case-control study was conducted in infants < 32 weeks gestation admitted to the Stanford Children’s NICU from 1/1/2020 to 12/31/2021. CBS was radiographically defined by a pediatric radiologist. Results: Analysis included 41 infants with CBS and 69 infants without. CBS was associated with younger gestational age (median 27.7 vs 30weeks, p < 0.001) and lower birthweight (median 1.00 vs 1.31kg, p < 0.001). Infants with CBS were more likely receive bilevel respiratory support and higher end expiratory pressure but have similar stooling patterns. Infants with CBS took longer to reach full enteral feeds (median 10 vs 7days, p = 0.003) and more abdominal radiographs. Conclusions: Future CBS therapies should target the smallest and youngest infants, focus on preventing air entry from above, and aim to reduce time to full enteral feeds and radiographic exposure.