title: Nasal continuous positive airways pressure immediately after extubation for preventing morbidity in preterm infants.
abstract: BACKGROUND
  Preterm infants being extubated following a period of intermittent positive pressure ventilation via an endotracheal tube are at risk of developing respiratory failure as a result of apnea, respiratory acidosis and hypoxia. Nasal continuous positive airway pressure appears to stabilise the upper airway, improve lung function and reduce apnea and may therefore have a role in facilitating extubation in this population.
  
  
  OBJECTIVE
  In preterm infants having their endotracheal tube removed following a period of intermittent positive pressure ventilation (IPPV), does management with nasal continuous positive airways pressure (NCPAP) lead to an increased proportion remaining free of additional ventilatory support, compared to extubation directly to headbox oxygen?
  
  
  METHODS
  Searches were made of the Oxford Database of Perinatal Trials, Medline, previous reviews including cross references, abstracts of conferences and symposia proceedings, expert informants, journal handsearching mainly in the English language and expert informant searches in the Japanese language by Prof. Ogawa.
  
  
  METHODS
  All trials utilising random or quasi-random patient allocation, in which NCPAP (delivered by any method) was compared with headbox oxygen for post-extubation care were included. Methodological quality was assessed independently by the two authors.
  
  
  METHODS
  Data were extracted independently by the two authors. Prespecified subgroup analysis to determine the impact of different levels of NCPAP, differences in duration of IPPV and use of aminophylline were also performed using the same package.
  
  
  RESULTS
  Nasal CPAP, when applied to preterm infants being extubated following IPPV, reduces the incidence of adverse clinical events (apnea, respiratory acidosis and increased oxygen requirements) indicating the need for additional ventilatory support. A reduction in the incidence of chronic lung disease at 28 days of age is also seen in the group extubated to NCPAP.
  
  
  CONCLUSIONS
  
  
  
  CONCLUSIONS
  nasal CPAP is effective in preventing failure of extubation and reducing oxygen use at 28 days of life in preterm infants following a period of endotracheal intubation and IPPV. Implication for research: further definition of the patient gestational age and weight groups in whom these results apply is required. Optimal levels of NCPAP as well as methods of administration remain to be determined.
authors.affiliation: Division of Paediatrics, Royal Women's Hospital, 132 Grattan St, Melbourne, Victoria, Australia, 3053. p.davis@obgyn-rwh.unimelb.edu.au
authors.forename: P G
authors.initials: PG
authors.lastname: Davis
authors.forename: D J
authors.initials: DJ
authors.lastname: Henderson-Smart
mesh_terms: D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000517:prevention & control*; D007385:Intermittent Positive-Pressure Ventilation; D007442:Intubation, Intratracheal; D011175:Positive-Pressure Respiration; D015300:Ventilator Weaning