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Kakkilaya V, Tang A, Wagner S, Ridpath J, Ibrahim J, Brown LS, Rosenfeld CR. Discontinuing Nasal Continuous Positive Airway Pressure in Infants ≤32 Weeks Gestational Age: A Randomized Control Trial. J Pediatr. 2020 Oct 27:S0022-3476(20)31343-3. doi: 10.1016/j.jpeds.2020.10.045. Epub ahead of print. PMID: 33127365.

Objectives: To compare immediate cessation of nasal continuous positive airway pressure (NCPAP) vs. a stepwise decrease in pressure on the duration of NCPAP therapy in infants born prematurely.

Study design: A single center study in infants 230-326 weeks gestational age (GA). NCPAP was stopped either at 5cm H2O (Control) or 3cm H2O after a stepwise pressure wean (Wean) using defined stability and failure criteria. Primary outcome is total NCPAP days.

Results: We enrolled 226 infants; 116 were randomly assigned to Control and 110 to the Wean group. There was no difference in the total NCPAP days between groups (median (25th,75th centiles) 16 (5,36) vs 14 (7,33) respectively). There were no differences between groups in secondary outcomes, including duration of hospital stay, critical care days and oxygen supplementation. A higher proportion of Control infants failed the initial attempt to discontinue NCPAP (43% versus 27%, respectively; P < .01) and required ≥2 attempts (20% versus 5%, respectively; P<0.01). Additionally, infants 23-27weeks GA in the Wean group were 2.4-times more likely to successfully stop NCPAP at the first attempt (P=0.02) versus Controls.

Conclusion: Discontinuation of NCPAP after a gradual pressure wean to 3cm H2O did not decrease the duration of NCPAP therapy compared with stopping from 5 cm H2O in infants ≤32 weeks GA. However, weaning decreased failed initial attempts to stop NCPAP, particularly among infants <28 week GA.

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