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Implementation of Nasal CPAP Weaning Guidelines in Preterm Infants
Shivani N Mattikalli1, Kimberly Wisecup2, Heather Stephens2
1Ms Mattikalli is affiliated with Pennsylvania State University College of Medicine, Hershey, Pennsylvania.
Insights
Implementing bubble Continuous Positive Airway Pressure (CPAP) weaning guidelines significantly improved successful CPAP weaning and oral feeding in preterm infants. This approach enhanced patient outcomes without increasing respiratory support duration or hospital stay.
Area of Science:
- Neonatal Medicine
- Pediatric Respiratory Care
- Clinical Quality Improvement
Background:
- Continuous Positive Airway Pressure (CPAP) is crucial for preterm infants with respiratory distress, reducing complications like bronchopulmonary dysplasia (BPD).
- Optimizing CPAP weaning is essential for promoting oral feeding and improving overall neonatal outcomes.
- Current consensus on optimal neonatal CPAP weaning strategies remains limited.
Purpose of the Study:
- To evaluate the impact of implementing standardized bubble CPAP gradual pressure weaning guidelines on neonatal outcomes.
- To assess changes in successful CPAP weaning rates and time to full oral feeds post-guideline implementation.
Main Methods:
- A quasi-experimental study comparing two epochs: pre-guideline implementation (2018-2019) and post-implementation (2020-2021).
- Inclusion criteria: infants < 32 weeks gestation receiving CPAP support.
- Primary process measure: adherence to CPAP weaning guidelines. Primary outcome: successful CPAP wean on the first attempt. Balancing measures: respiratory support duration and hospital length of stay.
Main Results:
- Post-guideline implementation, successful CPAP weaning increased from 9.5% to 54% (P < .001).
- Time to achieve full oral feeds decreased by 7 days (29 to 22 median days, P < .001).
- No significant differences were observed in BPD incidence, total respiratory support days, or hospital length of stay.
Conclusions:
- Implementation of bubble CPAP weaning guidelines significantly enhanced successful weaning rates in preterm infants.
- The new guidelines effectively promoted earlier achievement of full oral feeding.
- The strategy improved key process measures without adversely affecting major clinical outcomes.
Abstract:
Background: CPAP benefits preterm infants with respiratory distress, including reduced bronchopulmonary dysplasia (BPD) incidence, surfactant use, and extubation failure. Successful CPAP weaning also promotes oral feeding. However, there is no consensus on the optimal weaning of CPAP in neonates. This study aimed to determine the effects of CPAP weaning guideline implementation on neonatal outcomes. Methods: CPAP gradual pressure weaning guidelines were implemented in the Penn State Children's Hospital neonatal ICU in 2020. We included baseline data from infants (epoch 1) before guideline implementation in 2018-2019. We included infants (epoch 2) after implementing the guidelines during 2020-2021. The inclusion criteria were infants < 32 weeks gestation with CPAP support. Adherence with the CPAP weaning guidelines was the primary process measure. Primary outcome measures included successful CPAP wean on the first attempt. Balancing measures used were total days on respiratory support and hospital length of stay. Results: One hundred ninety-five infants were included in this study, 95 infants in epoch 1 before guideline implementation and 100 infants in epoch 2 after implementing guidelines. Infants in the 2 epochs were similar in median gestational age at 29 weeks versus 30 weeks (P = .47) and were similar in median birthweight at 1,190 g versus 1,130 g (P = .73). After implementing weaning guidelines, the successful weaning off CPAP improved from 9.5% to 54% (P < .001). The total days needed to achieve full oral feeds decreased by 7 d (29 median d vs 22 median d, P < .001). The BPD incidence was not significantly different between the 2 epochs at 17% versus 16%, P = .87. There was no difference in total days of respiratory support, total length of stay, the number of infants discharged on home nasogastric feeding, and demographic variables. Conclusions: The implementation of the bubble CPAP weaning guideline improved the successful weaning of CPAP and promoted oral feeding in preterm infants.
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