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Extended CPAP or low-flow nasal cannula for intermittent hypoxaemia in preterm infants: a 24-hour randomised clinical
Siamak Yazdi1, Waldemar A Carlo2, Arie Nakhmani3
1Department of Pediatrics, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA syazdi@uabmc.edu.
Insights
Extending continuous positive airway pressure (CPAP) for preterm infants reduced intermittent hypoxaemia and bradycardia compared to weaning to nasal cannula (NC). This finding aids in optimizing respiratory support for vulnerable newborns.
Area of Science:
- Neonatal Medicine
- Pediatric Respiratory Care
- Clinical Trial Research
Background:
- Optimal timing for discontinuing continuous positive airway pressure (CPAP) in preterm infants is not well-established.
- Intermittent hypoxaemia (IH) and respiratory instability are common concerns during CPAP weaning.
- This study investigated an alternative weaning strategy to mitigate these risks.
Purpose of the Study:
- To compare the efficacy of extended CPAP versus low-flow nasal cannula (NC) weaning in reducing IH and respiratory instability.
- To evaluate the impact of CPAP extension on secondary respiratory and oxygenation parameters in preterm infants.
Main Methods:
- A single-centre randomized clinical trial involving 36 preterm infants (<34 weeks gestation) meeting CPAP cessation criteria.
- Infants were randomized to either extended CPAP or weaning to low-flow NC for 24 hours.
- Primary outcome was the number of IH episodes (SpO2 <85% for ≥10s); secondary outcomes included SpO2 variability, oxygenation, and bradycardia.
Main Results:
- The CPAP group experienced significantly fewer IH episodes (median 20 vs. 76 per 24h; p=0.03) compared to the NC group.
- Infants on extended CPAP showed reduced bradycardia, less time with SpO2 <91% and <85%, and lower FiO2 requirements (all p<0.05).
- No significant differences were observed in IH <80%, transcutaneous CO2, or cerebral/renal oxygenation between groups.
Conclusions:
- Extended CPAP significantly decreases intermittent hypoxaemia and bradycardia in preterm infants ready for CPAP cessation.
- This strategy offers a potential benefit over immediate weaning to low-flow nasal cannula during the 24-hour intervention period.
- Further research may explore long-term outcomes and optimal duration of CPAP extension.
Objective:
Optimal timing of continuous positive airway pressure (CPAP) cessation in preterm infants remains undetermined. We hypothesised that CPAP extension compared with weaning to low-flow nasal cannula (NC) reduces intermittent hypoxaemia (IH) and respiratory instability in preterm infants meeting criteria to discontinue CPAP.
Design:
Single-centre randomised clinical trial.
Setting:
Level 4 neonatal intensive care unit.
Patients:
36 infants <34 weeks' gestation receiving CPAP≤5 cmH2O and fraction of inspired oxygen (FiO2) ≤0.30 and meeting respiratory stability criteria.
Interventions:
Extended CPAP was compared with weaning to low-flow NC (0.5 L/kg/min with a limit of 1.0 L/min) for 24 hours.
Outcomes:
The primary outcome was IH (number of episodes with SpO2<85% lasting ≥10 s). Secondary outcomes included: coefficient of variability of SpO2, proportion of time in various SpO2 ranges, episodes (≥10 s) with SpO2<80%, median cerebral and renal oxygenation, median effective FiO2, median transcutaneous carbon dioxide and bradycardia (<100/min for≥10 s).
Results:
The median (IQR) episodes of IH per 24-hour period was 20 (6-48) in the CPAP group and 76 (18-101) in the NC group (p=0.03). Infants continued on CPAP had less bradycardia, time with SpO2 <91% and <85%, and lower FiO2 (all p<0.05). There were no statistically significant differences in IH<80%, median transcutaneous carbon dioxide or median cerebral or renal oxygenation.
Conclusion:
In preterm infants meeting respiratory stability criteria for CPAP cessation, extended CPAP decreased IH, bradycardia and other hypoxaemia measures compared with weaning to low-flow NC during the 24-hour intervention.
Trial Registration Number:
NCT04792099.
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