title: Elective use of nasal continuous positive airways pressure following extubation of preterm infants.
abstract: The aim of this study was to determine whether elective use of nasal continuous positive airways pressure (CPAP) following extubation of preterm infants was well tolerated and improved short- and long-term outcomes. A randomized comparison of nasal CPAP to headbox oxygen was undertaken and a meta-analysis performed including similar randomized trials involving premature infants less than 28 days of age. A total of 150 infants (median gestational age 30 weeks, range 24-34 weeks) were randomized in two centres. Fifteen nasal CPAP infants and 25 headbox infants required increased respiratory support post-extubation and 15 nasal CPAP infants and nine headbox infants required reintubation (non significant). Eight infants became intolerant of CPAP and were changed to headbox oxygen within 48 h of extubation; 19 headbox infants developed apnoeas and respiratory acidosis requiring rescue nasal CPAP, 3 ultimately were re-intubated. Seven other trials were identified, giving a total number of 569 infants. Overall, nasal CPAP significantly reduced the need for increased respiratory support (relative risk, 0.57, 95% CI 0.43-0.73), but not for re-intubation (relative risk 0.89, 95% CI 0.68-1.17). Nasal CPAP neither influenced significantly the intraventricular haemorrhage rate reported in four studies (relative risk 1.0, 95% CI 0.55, 1.82) nor that of oxygen dependency at 28 days reported in six studies (relative risk 1.0, 95% CI 0.8, 1.25). In two studies nasal CPAP had to be discontinued in 10% of infants either because of intolerance or hyperoxia.
  
  
  CONCLUSIONS
  Elective use of nasal continuous positive airways pressure post-extubation is not universally tolerated, but does reduce the need for additional support.
authors.affiliation: Children Nationwide Regional Neonatal Intensive Care Centre, King's College Hospital, London, UK.
authors.forename: G
authors.initials: G
authors.lastname: Dimitriou
authors.forename: A
authors.initials: A
authors.lastname: Greenough
authors.forename: V
authors.initials: V
authors.lastname: Kavvadia
authors.forename: B
authors.initials: B
authors.lastname: Laubscher
authors.forename: C
authors.initials: C
authors.lastname: Alexiou
authors.forename: V
authors.initials: V
authors.lastname: Pavlou
authors.forename: S
authors.initials: S
authors.lastname: Mantagos
mesh_terms: D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D011175:Positive-Pressure Respiration / Q000379:methods*; D015300:Ventilator Weaning