Gradual versus sudden weaning from nasal CPAP in preterm infants: a pilot randomized controlled trial

• Published in: Respiratory care 2013-03, Vol.58 (3), p.511-516
• Main Authors: Rastogi, Shantanu, Wong, Wendy, Gupta, Anju, Bhutada, Alok, Maimonides Neonatal Group
• Format: Article
• Language: English
• Subjects: Care and treatment; Continuous positive airway pressure; Continuous Positive Airway Pressure - methods; Diseases; Female; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Infants (Newborn); Length of Stay - statistics & numerical data; Male; Patient outcomes; Pilot Projects; Prospective Studies; Respiratory distress syndrome; Treatment Outcome; Ventilator Weaning - methods
• ISSN: 0020-1324; 1943-3654
• DOI: 10.4187/respcare.01999

There is paucity of information on the weaning of nasal CPAP (NCPAP) in preterm infants. As the weaning from NCPAP can be gradual or sudden, we wanted to determine which of the 2 methods was better. A prospective randomized trial was conducted to compare the success of weaning from NCPAP when using the sudden and gradual weaning methods in infants born ≤ 32 weeks. We also compared the weight, post-menstrual age when these infants were successfully weaned from NCPAP, and their length of stay in the hospital. Of the 56 infants included in the study, 28 infants were randomized to each weaning method. The gestational age, birth weight, and other clinical factors were similar between the 2 groups. There was no difference in the rate of success of initial weaning between the 2 methods (P = .65). The infants were successfully weaned at 33.7 ± 2.8 weeks versus 33.8 ± 2.6 weeks (P = .93) post-menstrual age, and at 1,736 ± 487 g versus 1,736 ± 501 g (P = .99) weight in the sudden wean and gradual wean groups, respectively. Length of stay was 61.3 ± 19.6 days for the sudden wean group and 66.0 ± 27.1 days for the gradual wean group (P = .48). There was no difference in the success of weaning from NCPAP between the 2 weaning methods. The weight and postmenstrual age at the time of successful NCPAP wean also did not differ between the 2 groups. These findings suggest that factors other than the method of CPAP wean, such as pulmonary maturity, may determine the success of NCPAP wean in preterm infants.