Suzanne Greenleaf Martin, Christa Matrone, Mark Stephens, Thais Queliz Pena, Mary Schreck, Richard A Guerrero, Angela Zimmerman, Samer K Elbabaa, Ryan Jafrani, Brent Golden
Extremely premature infants with severe BPD requiring prolonged high-pressure mechanical ventilation may be vulnerable to a novel phenotype of atypical craniosynostosis marked by accelerated head circumference growth, craniosynostosis, and calvarial thickening. Prospective studies are needed to define ventilatory exposure thresholds, clarify mechanisms, and determine neurologic and surgical implications.
OBJECTIVE: To describe an atypical pattern of secondary craniosynostosis observed in premature infants with severe bronchopulmonary dysplasia (BPD) who required prolonged high-pressure ventilation and tracheostomy.
STUDY DESIGN: A single-center retrospective chart review of infants born between January 2020 and May 2025. Inclusion criteria were gestational age 22-28 weeks, severe BPD, tracheostomy placement, and radiologic variables from the medical record.
RESULT: Ten patients met inclusion criteria. The greatest 4-week rise in head circumference percentile was 43 ± 14 percentile points, exceeding concurrent changes in weight and length (P = 0.0023). The weighted mean sustained positive end-expiratory pressure was 10.6 cm H₂O.
CONCLUSION: Extremely premature infants with severe BPD requiring prolonged high-pressure mechanical ventilation may be vulnerable to a novel phenotype of atypical craniosynostosis marked by accelerated head circumference growth, craniosynostosis, and calvarial thickening. Prospective studies are needed to define ventilatory exposure thresholds, clarify mechanisms, and determine neurologic and surgical implications.