Factors Affecting the Weaning from Nasal CPAP in Preterm Neonates

Abstract

Objective. Identification of the weight and postmenstrual age (PMA) at successful weaning of NCPAP in preterm neonates and the factors influencing the successful wean. Study Design. Retrospective review of 454 neonates ≤32 weeks of gestational age (GA) who were placed on NCPAP and successfully weaned to room air was performed. Results. Neonates had a mean birth weight (BW) of 1357 ± 392 grams with a mean GA of 29.3 ± 2.2 weeks. Neonates were weaned off NCPAP at mean weight of 1611 ± 432 grams and mean PMA of 32.9 ± 2.4 weeks. Univariate analysis showed that chorioamnionitis, intubation, surfactant use, PDA, sepsis/NEC, anemia, apnea, GER and IVH were significantly associated with the time to NCPAP wean. On multivariate analysis, among neonates that were intubated, BW was the only significant factor (P < 0.001) that was inversely related to time to successful NCPAP wean. Amongst non-intubated neonates, along with BW (P < 0.01), chorioamnionitis (P < 0.01), anemia (P < 0.0001), and GER (P < 0.02) played a significant role in weaning from NCPAP. Conclusion. Neonates were weaned off NCPAP at mean weight of 1611 ± 432 grams and mean PMA of 32.9 ± 2.4 weeks. BW significantly affects weaning among intubated and non-intubated neonates, though in neonates who were never intubated chorioamnionitis, anemia and GER also significantly affected the duration on NCPAP.

CeasIng Cpap At standarD criteriA (CICADA): predicting a successful outcome

“…There were fewer PBs in the fast group with a PDA compared to those in the slow group, and a co-linearity association between PDA and both GA and Bwt was observed. However, no association between CPAP ceasing and PDA was identified, which was in agreement with the results obtained from previous authors [14,23]. Others have found a PDA especially if prolonged and significant is associated with longer ventilation and CLD [18,26].…”

“…Linear regression results showed that Bwt was the only significant negative predictor for both CPAP duration and CPAP ceasing attempts. Our study found that for every 100-g increase in Bwt, there is a decrease in CPAP duration by 0.4 weeks, compared to the decrease in 0.2 weeks found by a recent trial [23]. The reason for the difference may be the GA and Bwt of the PBs in our study ranged from 25-29 weeks and 0.5-1.5 kg, respectively, compared with those of 24-32 weeks in GA and 0.6-2.6 kg in Bwt of others [23,27].…”

“…This is supported by evidence that there is delayed structural lung growth in extremely premature babies who develop CLD [19]. Other than lung immaturity and delay in development, some have suggested that the delayed ceasing of CPAP for PBs of lower Bwt was related to the ventilation-induced lung injury associated with intubation and positive-pressure ventilation [23]. Ventilation-induced lung injury for delay in ceasing CPAP is supported in the current study as the PBs in the fast group were ventilated for a significantly shorter period (Table 2).…”

“…In our study, we compared clinical factors believed to influence CPAP ceasing such as antenatal steroids (complete course) [11], presence of chorioamnionitis [1,3,19], presence of premature rupture of membranes (longer than 1 day) [21], use of surfactant [2,6,25], the presence of PDA [18], presence of intraventricular haemorrhage (IVH) [4,23] and the presence of sepsis [23]. No significant differences in frequencies of these clinical conditions other than the presence of PDA were observed.…”

Prevalencia de lesao do septo nasal em prematuros no uso de prongas nasais

“…In this study, no association was found between GA and the appearance of lesions in preterm infants receiving nasal septum NIV. Such association is directly related to the appearance of skin lesions due to the immaturity of the tissues (10,(27)(28)(29)(30) .…”