Randomized controlled trial of discontinuation of nasal-CPAP in stable preterm infants breathing room air

Abstract

This trial assessed the consequences of discontinuation of nasal-CPAP in stable preterm infants breathing room air. Eighty-eight infants with a mean gestational age of 29 (24-33) weeks and a mean birthweight of 1264 (665-2060)g, randomized to either discontinuation of CPAP or its continuation, were clinically observed and monitored for 6 h by cardiorespiratory monitor, pulse oximeter and transcutaneous blood gas monitor. The abdominal circumference and gastric air and aspirate volumes were measured prior to meals at trial entry and after 6 h. Discontinuation of CPAP led to a small but significant decrease in oxygenation at 1 and 6 h. During the trial, five infants in the experimental group required supplemental oxygen and one infant was put back on CPAP owing to excessive apnoeas. Discontinuation of CPAP did not influence the TcPCO2 or the number of apnoeas and bradycardias during the trial, but led to significantly increased respiratory rate, retractions, and flaring at 6 h. It also led to a significant decrease in the abdominal circumference and gastric air volume. Thirty-nine percent of infants were put back on CPAP some time after the trial, mainly because of recurrent apnoeas and bradycardias. Taking the infant off CPAP during the trial reduced subsequent use of CPAP.

Weaning of nasal CPAP in preterm infants: who, when and how? a systematic review of the literature

“…The weaning methods included sudden removal of NCPAP with or without oxygen supplementation, gradual increase in time off NCPAP, gradual reduction of pressure followed by removal of NCPAP, or a combination of these methods. [19–25] …”

A Randomized Trial of Low-Flow Oxygen versus Nasal Continuous Positive Airway Pressure in Preterm Infants

“…The standard deviation was assumed to be 0.13 [22] . Outcome data were analyzed by 'intention-to-treat'.…”

Duration of continuous positive airway pressure in premature infants

“…Sufficient compromise of pulmonary blood flow may actually worsen ventilation/perfusion mismatch and impair oxygenation [17–19]. Gastric distension [20] – so-called “CPAP belly” – may aggravate feeding intolerance and provoke gastroesophageal reflux, itself a risk factor for ongoing lung injury [21,22]. Prolonged CPAP use may delay initiation of oral feeds, prolong hospitalization, limit infant holding, and constrain developmental therapies [23].…”

“…Our review of the literature identified three observational studies [27,32,33] and eight small to medium-sized randomized trials [20,34–40]. Neither of two systematic reviews [28,41] with differing objectives and study inclusions pooled data for meta-analysis due to low data quality and trial heterogeneity.…”

“…Trials by Abdel-Hady et al [20,36] supply clinical evidence that prolonged CPAP use improves oxygenation and reduces the need for supplemental oxygen well beyond the immediate postnatal period. This has biologic plausibility and face validity.…”