Weaning Preterm Neonates From Nasal Continuous Positive Airway Pressure

A Randomized Controlled Trial on Weaning Preterm Neonates From Nasal Continuous Positive Airway Pressure

There is little data published concerning the best approach to nasal continuous positive airway pressure (nCPAP) weaning. Potential complications associated with prolonged nCPAP therapy include gastric distension, nasal trauma,pneumothorax,agitation and nosocomial infection. Moreover, Infants on nCPAP may also require more intensive nursing care and the use of extra equipment. Therefore, minimizing the amount of time that a patient requires CPAP may be beneficial. On the other hand, removing CPAP too early may lead to complications that include: increasing apnea, increased oxygen requirement, increased work of breathing, the need to re-start CPAP, and intubation and mechanical ventilation. Moreover, an experimental study have demonstrated an improvement in lung growth after the prolonged use of CPAP.

Nasal cannula (NC) flows at 1-2 L/min may also generate a positive pressure in the airway of preterm infants. The use of NC flow to generate positive airway pressure would minimize many of the application issues of nCPAP. However, NC systems used in neonates routinely employ gas that is inadequately warmed and humidified, limiting the use of such flows due to increased risk of nasal mucosa injury, and possibly increasing the risk for nosocomial infection.

The purpose of this randomized controlled trial is to evaluate the clinical impact of two methods for weaning preterm infants from nCPAP.

The objective of this study is to test the null hypothesis that in preterm infants with gestational age of 28 to 36 weeks who are stable on CPAP pressure of 5 cmH2O and with oxygen concentrations (FiO2) <0.30, keeping these infants on CPAP or changing them to NC flow of 1-2 L/min will not make any difference in length of hospitalization, length of respiratory support and incidence of complications.

Inclusion Criteria:

• Infants born greater than or equal to 28 weeks (28+0) and less than 37 weeks (36+6) gestation

• CPAP pressure of 5 cm H2O

• FiO2 requirement = or <0.30

• Clinically stable on these CPAP parameters for 24 hours pre-randomization:

  • Respiratory rate less than 60
  • No significant chest recession
  • No apnea requiring bagging and/or
  • Not more than 6 apneas requiring stimulation in the preceding 24 h.
  • Average saturation > or = 87%
  • Satisfactory ABG (pH> 7.25, PCO2 < 60, and Base deficit < -8)

Exclusion Criteria:

• Life threatening congenital anomalies
• Congenital cyanotic heart diseases
• Congenital airway or chest wall abnormalities
• Pulmonary hypoplasia
• Known or suspected to have a neuromuscular disorder
• Congenital neurological disorder, severe IVH (grade 3 or 4), PVL and hydrocephalus