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Duration of apnoea before start of backup ventilation during nCPAP in extremely preterm infants and time spent within

Stephanie Ströbele1, Tibor Jung2, Dominik Kraft2

  • 1Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm, Germany stephanie.stroebele@uniklinik-ulm.de.

Archives of Disease in Childhood. Fetal and Neonatal Edition
|September 27, 2025
PubMed

Insights

Shortening the apnoea duration before backup ventilation (BUV) did not improve oxygen saturation targets in extremely preterm infants on nasal continuous positive airway pressure (nCPAP). Further research is needed to optimize non-invasive respiratory support settings.

Area of Science:

  • Neonatal Medicine
  • Respiratory Physiology
  • Pediatric Critical Care

Background:

  • Central apnoea is a primary cause of desaturations in extremely preterm (EPT) infants (<28 weeks).
  • Nasal continuous positive airway pressure (nCPAP) with backup ventilation (BUV) is a common respiratory support strategy.
  • Optimizing BUV settings is crucial for maintaining adequate oxygenation in EPT infants.

Purpose of the Study:

  • To investigate the impact of varying apnoea duration (AD) before BUV on oxygenation measures in EPT infants receiving nCPAP.
  • To compare the time spent within the target oxygen saturation range (SpO2) between shorter (AD 4) and longer (AD 16) apnoea durations.

Main Methods:

  • A single-centre randomized cross-over trial was conducted in a Level 3 neonatal intensive care unit.
  • Twenty-four EPT infants (<28 weeks) on nCPAP with BUV participated.
  • The primary outcome was the time spent within the SpO2 target (88%-95%) during AD 4 versus AD 16.

Main Results:

  • Twenty-two infants completed the study (median GA 24+5 weeks).
  • No significant difference was found in the mean time spent within the SpO2 target between AD 4 (66.9%) and AD 16 (67.2%) (p=0.88).
  • No differences were observed in hypoxemia episodes, cerebral oxygenation, or other physiological parameters, although BUV rate was higher in AD 4.

Conclusions:

  • Reducing apnoea duration before BUV does not improve oxygen saturation targeting in respiratory unstable EPT infants.
  • Current non-invasive respiratory support settings may require further optimization.
  • Intensified research efforts are needed to define optimal BUV parameters for EPT infants.
Abstract

Keywords:
Child DevelopmentIntensive Care Units, NeonatalNeonatology

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