effective approaches & strategies to ease off nasal cpap in preterm infants

Conditions: Neonatal Respiratory Distress Syndrome; Extremely Low Birth Weight Infant (ELBW); BronchoPulmonary Dysplasia

Summary: though nasal continuous positive airway pressure (ncpap) is a commonly used form of non-invasive neonatal respiratory support, the optimal method of weaning off ncpap is not well established. in this prospective, two-center randomized control trial we hypothesize that gradually increasing time off ncpap (sprinting) increases the success of weaning ncpap off in infants born between 23 0/7-30 6/7 weeks of gestational age.

eligible infants admitted to two neonatal intensive care units (nicus) were randomized to a sprinting (sp) vs. a non-sprinting (nsp) protocol, both over 4 days. infants assigned to the sp group sprinted twice daily for 3h (day 1), 6h (day 2), 9h (day 3) \& then 24h back on ncpap (day 4) before switching to nasal cannula (nc) on day 5. infants in the nsp group were maintained on ncpap of 5 cm of water for the first 4 days before switching to nc on day 5, similar to the sp group. infants in both groups were observed for the next 3 days (day 5-7) to ensure stability off cpap

Eligibility criteria:
inclusion criteria: * born between 23 0/7 - 30 6/7 weeks ga * at least 26 0/7 weeks corrected ga. * on ncpap for at least 24 hours * stable on ≤0.3 fio2 for at least 24 hours initiation of study protocol, i.e., weaning from ncpap, was started when infant met all of the following criteria for at least 24 hours: * requiring ncpap of 4-6 cm of h2o and fio2 ≤0.3. * all babies \< 32 weeks corrected ga should have been loaded or already on maintenance caffeine (caffeine citrate 20 mg/kg as the loading and 5-10 mg/kg as the maintenance dose). * stable respiratory system assessment (respiratory rate of \ 86%) and otherwise deemed clinically stable for weaning off non-invasive ventilation by medical team * if post-surgery, infant must be at least 2 weeks post-operative and off antibiotics with no concern or need for repeat surgery. * a documented hemoglobin of more than 8 g/dl within 7 days of initiation of the study. * meeting "stability criteria" defined below: * the infant had to be tolerating a flow of no more than 2 liters nc on a fio2 of 0.30 or less to keep oxygen saturations above 85% (should match what you wrote below in failure criteria)%. * have a respiratory rate of less than 70 on average over 24 hours for more than 24 hours * the infant could have no significant chest recession (sternal/diaphragmatic) exclusion criteria: * evidence of a hemodynamically or clinically significant (worsening respiratory status or pulmonary edema on chest x-ray) patent ductus arteriosus, diagnosed either clinically or echocardiographically. * any significant congenital abnormality (abnormalities affecting a major organ system, airway, or musculoskeletal system). * hemodynamic/respiratory instability or currently being treated for suspected or proven sepsis (positive blood culture) * grade iv intraventricular hemorrhage * inability to obtain informed parental consent

Keywords: cpap extremely low birth weight infant (elbw) non-invasive respiratory support premature infants non invasive ventilation weaning