Abstract
BackgroundThe optimal strategy for weaning very preterm infants from nasal continuous positive airway pressure (NCPAP) is unclear. Reported strategies include weaning NCPAP to a predefined pressure then trialling stopping completely (abrupt wean); alternate periods of increased time off NCPAP whilst reducing time on until the infant is completely weaned (gradual wean); and using high flow nasal cannula (HFNC) to assist the weaning process. The aim of this study was to determine the optimal weaning from NCPAP strategy for very preterm infants.MethodsA pilot single centre, factorial design, 4-arm randomised controlled trial. Sixty infants born <30 weeks gestation meeting stability criteria on NCPAP were randomly allocated to one of four groups. Group 1: abrupt wean with HFNC; Group 2: abrupt wean without HFNC; Group 3: gradual wean with HFNC; Group 4: gradual wean without HFNC. The primary outcomes were duration of respiratory support, chronic lung disease, length of hospital stay and time to full suck feeds.ResultsThe primary outcome measures were not significantly different between groups. Group 1 had a significant reduction in duration of NCPAP (group 1: median 1 day; group 2: 24 days; group 3: 15 days; group 4: 24 days; p = 0.002) and earlier corrected gestational age off NCPAP. There was a significant difference in rate of parental withdrawal from the study, with group 2 having the highest rate. Group 3 had a significantly increased duration on HFNC compared to group 1.ConclusionsUse of high flow nasal cannula may be effective at weaning infants from NCPAP but did not reduce duration of respiratory support or time to full suck feeds. Abrupt wean without the use of HFNC was associated with an increased rate of withdrawal by parent request.Trial registrationThis study is registered at the Australian New Zealand Clinical Trials Registry (www.anzctr.org.au/). (Registration Number = ACTRN12610001003066).
Highlights
The optimal strategy for weaning very preterm infants from nasal continuous positive airway pressure (NCPAP) is unclear
Tang et al BMC Pediatrics (2015) 15:147 nasal cannula (HFNC) using flow rates greater than 1 L/ min [9] are being used as an alternative to NCPAP
Previous research reported that use of high flow nasal cannula (HFNC) in preterm infants for weaning from NCPAP is associated with an increased exposure to oxygen and longer duration of respiratory support
Summary
The optimal strategy for weaning very preterm infants from nasal continuous positive airway pressure (NCPAP) is unclear. Reported strategies include weaning NCPAP to a predefined pressure trialling stopping completely (abrupt wean); alternate periods of increased time off NCPAP whilst reducing time on until the infant is completely weaned (gradual wean); and using high flow nasal cannula (HFNC) to assist the weaning process. Trials comparing use of HFNC versus NCPAP for facilitating extubation in preterm infants report similar efficacy for prevention of extubation failure [12, 13] and reduced nasal trauma with HFNC [14]. [15] HFNC flow was restricted to 2 L/min and infants weaned from NCPAP were on a relatively high fraction inspired oxygen (FiO2 ≤ 0.3) so may have had relatively severe lung disease Previous research reported that use of HFNC in preterm infants for weaning from NCPAP is associated with an increased exposure to oxygen and longer duration of respiratory support. [15] HFNC flow was restricted to 2 L/min and infants weaned from NCPAP were on a relatively high fraction inspired oxygen (FiO2 ≤ 0.3) so may have had relatively severe lung disease
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