Discontinuing Nasal Continuous Positive Airway Pressure in Infants ≤32 Weeks of Gestational Age: A Randomized Control Trial

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 of gestational age. NCPAP was stopped either at 5 cm H₂O (control) or 3 cm 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 percentiles] 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% vs 27%, respectively; P <.01) and required ≥2 attempts (20% vs 5%, respectively; P <.01). In addition, infants 23-27 weeks of gestational age in the wean group were 2.4-times more likely to successfully stop NCPAP at the first attempt (P =.02) vs controls. Conclusions: Discontinuation of NCPAP after a gradual pressure wean to 3 cm H₂O did not decrease the duration of NCPAP therapy compared with stopping from 5 cm H₂O in infants ≤32 weeks of gestational age. However, weaning decreased failed initial attempts to stop NCPAP, particularly among infants <28 weeks of gestational age. Trial registration: Clinicaltrials.gov: NCT02064712.