nCPAP In Infants Research Articles

The ideal strategy of weaning from nasal continuous positive airway pressure in preterm infants: are we there yet?

Commentary on: Jensen CF, Sellmer A, Ebbesen F, et al. Sudden vs pressure wean from nasal continuous positive airway pressure in infants born before 32 weeks of gestation: a randomized clinical trial. JAMA Pediatr 2018 Jul 23. pii: 2687936. https://doi.org/10.1001/jamapediatrics.2018.2074. PMID: 30039171. The ideal strategy of weaning off nCPAP is not established. Premature discontinuation may lead to atelectasis, apnoea and bradycardia, respiratory distress, prolonged oxygen therapy and ultimately lung injury 1. On the other hand, undue prolonged therapy increases the risk of nasal trauma, gastric distension, pneumothorax and agitation 2. Previous studies showed conflicting results. Amatya et al. 3 found that more infants in the gradual wean group were successfully weaned off nCPAP as compared with the sudden wean group, with no difference in respiratory morbidity, weight gain, days on nCPAP and length of hospital stay. In contrast, Eze et al. 4 demonstrated that weaning CPAP in very preterm infants via sprinting (gradual increasing spontaneous breathing off nCPAP) versus weaning pressure down were comparable, regarding successful weaning and the occurrence of common neonatal morbidities. Jensen et al. have shown no difference in weight gain velocity from randomisation to 40 weeks PMA and in secondary outcomes between preterm infants born before 32 weeks of gestation, randomised to sudden weaning versus pressure weaning from nCPAP. The discrepancy in the findings of the Jensen et al.’ study and previous studies may be related to differences in gestational age and the severity of respiratory dysfunction, as infants enrolled in Jensen et al. and Amatya et al.’ studies had higher gestational age [median GA 30 (29–31), mean 28.7 ± 1.8 weeks, respectively], compared to Eze et al. [median 26.5 (23.6–30.6) weeks] and had less severe respiratory dysfunction as the need for surfactant was 36, 20%, respectively versus 63–73% in Eze et al. study. More infants <28 weeks of gestation at birth were successfully weaned from nCPAP during the first attempt in the pressure wean group compared with the sudden wean group. Similarly, Soe et al. 5 found that pressure weaning was more effective than cycling off nCPAP in infants born 24–27 weeks of gestation but not in infants over 28 weeks of gestation at birth. This may indicate that pressure weaning is more appropriate in these infants or that they should have different readiness to wean from nCPAP criteria such as lower FiO2 requirements, lower nCPAP pressure and older postnatal age. This is the largest RCT to date to compare sudden wean and pressure wean of very preterm infants from CPAP. However, the results of this study should be interpreted with caution, due to some limitations such as: Where do we go from here? In preterm infants <32 weeks of gestation, sudden discontinuation and gradual pressure weaning strategies seem to be equally effective approaches for weaning from nCPAP, and pressure wean may be preferred in infants who <28 weeks of gestation. However, future studies are warranted for refinement of readiness to wean from nCPAP criteria and to study the influence of different nCPAP weaning strategies on long-term pulmonary and neurodevelopmental outcomes. https://ebneo.org/2018/12/2018-12-weaning-from-nasal-cpap/ None. None.

Usefulness of nCPAP in infants with bronchiolitis: A clinical study

Background: Bronchiolitis is characterized by edema and mucus secretions. It is common in infants. The present study was conducted to assess usefulness of CPAP in infants with bronchiolitis. Materials & Methods: The present study was conducted on 68 children of 1 month to 1 years of age of both genders. All patients were divided into 2 groups of 34 each. Group I received bubble CPAP in addition to the standard care and group II received standard care, which included maintenance of adequate hydration and oxygenation. All children were monitored continuously and respiratory rate, SA score and Modified Pediatric Society of New Zealand Severity Score (MPSNZ-SS) was compared. Results: Group I had 20 boys and 14 girls and group II had 18 boys and 16 girls. Respiratory rate was 72 and 68 respectively in group I and II. SA score was 4.3 and 3.9 respectively in group I and II. MPSNZ-SS was 12.5 and 11.8 respectively in group I and II. The difference was non- significant (P> 0.05). Respiratory rate after 1 hour was 9 and 6 respectively in group I and II. SA score was 0.82 and 0.43 respectively in group I and II. MPSNZ-SS was 2.4 and 1.7 respectively in group I and II. The difference was significant (P< 0.05). Conclusion: Authors found that nCPAP is an effective method of reducing respiratory distress in infants suffering from bronchiolitis.

Infant flow biphasic nasal continuous positive airway pressure (BP- NCPAP) vs. infant flow NCPAP for the facilitation of extubation in infants' ≤ 1,250 grams: a randomized controlled trial

BackgroundThe use of mechanical ventilation is associated with lung injury in preterm infants and therefore the goal is to avoid or minimize its use. To date there is very little consensus on what is considered the "best non-invasive ventilation mode" to be used post-extubation. The objective of this study was to compare the effectiveness of biphasic nasal continuous positive airway pressure (BP-NCPAP) vs. NCPAP in facilitating sustained extubation in infants ≤ 1,250 grams.MethodsWe performed a randomized controlled trial of BP-NCPAP vs. NCPAP in infants ≤ 1,250 grams extubated for the first time following mechanical ventilation since birth. Infants were extubated using preset criteria or at the discretion of the attending neonatologist. The primary outcome was the incidence of sustained extubation for 7 days. Secondary outcomes included incidence of adverse events and short-term neonatal outcomes.ResultsSixty-seven infants received BP-NCPAP and 69 NCPAP. Baseline characteristics were similar between groups. The trial was stopped early due to increased use of non-invasive ventilation from birth, falling short of our calculated sample size of 141 infants per group. The incidence of sustained extubation was not statistically different between the BP-NCPAP vs. NCPAP group (67% vs. 58%, P = 0.27). The incidence of adverse events and short-term neonatal outcomes were similar between the two groups (P > 0.05) except for retinopathy of prematurity which was noted to be higher (P = 0.02) in the BP-NCPAP group.ConclusionsBiphasic NCPAP may be used to assist in weaning from mechanical ventilation. The effectiveness and safety of BP-NCPAP compared to NCPAP needs to be confirmed in a large multi-center trial as our study conclusions are limited by inadequate sample size.Clinical Trials Registration #NCT00308789Source of supportGrant # 06-06, Physicians Services Incorporated Foundation, Toronto, Canada. Summit technologies Inc. provided additional NCPAP systems and an unrestricted educational grant. presented at The Society for Pediatric Research Meeting, Baltimore, USA, May 2nd-5th, 2009 and Canadian Paediatric Society Meeting, June 23rd-29th, Ottawa, 2009.

Clinical predictors of nasal continuous positive airway pressure requirement in acute bronchiolitis

There is growing use of nasal continuous positive airway pressure ventilation (nCPAP) for infants with bronchiolitis, based on clinical assessment of severity. Despite this there have been no studies which identify clinical predictors for the requirement of nCPAP. To identify clinical factors in infants with acute bronchiolitis in the emergency department (ED), which might predict a requirement for nCPAP following admission. Retrospective review of pediatric ED case notes was conducted on bronchiolitis admissions to one dedicated Paediatric ED over a 12-month period. Potential predictors were identified through literature review. Data extraction of predictors was carried out and recorded for each case. Logistic regression was conducted for each variable to identify statistically significant predictors of nCPAP requirement. Twenty-eight (17%) of the 163 admitted infants received nCPAP. The strongest predictors of nCPAP requirement in were as follows: oxygen requirement within the ED (P < 0.001), lower oxygen saturation (P < 0.001), younger age at presentation (P = 0.002), higher respiratory rate (P = 0.002), higher heart rate (P = 0.003), lower Glasgow Coma Scale score (0.006), and younger gestational age (P = 0.024). We have identified clinical variables that were predictive of nCPAP requirement in infants admitted to our unit with bronchiolitis, oxygen requirement in the ED being the strongest single predictor. This is the first such study in the UK, and we hope it may be a starting point for further work that may provide an evidence base to aid clinicians in predicting the use of nCPAP in infants with bronchiolitis.

Sustainable use of continuous positive airway pressure in extremely preterm infants during the first week after delivery

Background: Early use of nasal continuous positive airway pressure (nCPAP) may reduce lung damage, but it is not clear how many extremely preterm infants can be cared for without mechanical...

Prophylactic nasal continuous positive airways pressure in newborns of 28–31 weeks gestation: multicentre randomised controlled clinical trial

Background: The role of nasal continuous positive airways pressure (nCPAP) in the management of respiratory distress syndrome in preterm infants is not completely defined. Objective: To evaluate the benefits and...