1. Among infants born ≤ 32 weeks gestational age requiring nasal continuous positive airway pressure (NCPAP), a gradual pressure wean to 3 cm H2O versus stopping at the level of approximately 5 cm H2O did not change the total number of days spent on NCPAP.
Evidence Level Rating: 1 (Excellent)
For infants born prematurely, nasal continuous positive airway pressure (NCPAP) is a mainstay of respiratory support that decreases the need for mechanical ventilation, improves outcomes, and minimizes the incidence of bronchopulmonary dysplasia. It is not, however, without risks; NCPAP is associated with an increased risk of nasal septal injury, pneumothorax, and gastric distention, among others. As such, there is a desire to minimize time spent on NCPAP. This randomized controlled trial examined two strategies of stopping NCPAP – gradual pressure weaning to 3 cm H2O (wean cohort) and stopping at the level of approximately 5 cm H2O (control cohort) – among premature infants ≤ 32 weeks gestational age. The primary outcome was the total days of NCPAP, defined as the need for any NCPAP support within a 24-hour period. 116 infants were randomized to the control cohort (mean [SD] age = 28  weeks, 55% male) and 110 infants to the wean cohort (mean [SD] age = 29  weeks, 51% male). It was found that the total number of days on NCPAP did not differ significantly between the control and wean cohorts (median 16 vs. 14 days, p = 0.56). However, the control cohort was nearly twice as likely to fail the first attempt at stopping NCPCP (p = 0.01) and four-times more likely to have two or more failed attempts at stopping (p < 0.01). In a subgroup analysis, grouping infants 23 to 27 and 28 to 32 weeks gestational age, there was again no difference in the primary outcome. Overall, this study demonstrated that stopping NCPAP at 5 cm H2O compared with a gradual pressure wean from 5 to 3 cm H2O had no difference on the total duration of NCPAP therapy among infants ≤ 32 weeks gestational age, though a strategy of gradually weaning pressure significantly decreased the incidence of failure to stop NCPAP.
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