title: Early weaning from CPAP to high flow nasal cannula in preterm infants is associated with prolonged oxygen requirement: a randomized controlled trial.
abstract: OBJECTIVE
  To determine the better approach for weaning preterm infants from nasal continuous positive airway pressure (NCPAP) with or without transitioning to nasal cannula (NC).
  
  
  METHODS
  This is a randomized, open label, controlled trial. Preterm infants born at ≥28 weeks gestation who were clinically stable on NCPAP of 5 cm H(2)O with FiO(2)<0.30 for at least 24 h were randomly assigned to one of 2 groups. The no-NC group were kept on NCPAP until they were on FiO(2)=0.21 for 24 h, and then were weaned off NCPAP completely without any exposure to NC. If they met failing criteria, NCPAP was re-instituted. The NC-group was weaned off NCPAP when FiO(2) was ≤0.30 to NC (2 L/min) followed by gradual weaning from oxygen. Infants who failed NC were supported back with NCPAP for 24 h before making a second attempt of NC.
  
  
  RESULTS
  Sixty neonates were enrolled; 30 in each group. The two groups were similar in birthweight, gestational age, sex, antenatal steroids, mode of delivery, use of surfactant and xanthines, and duration of mechanical ventilation. After randomization, the no-NC group had fewer days on oxygen [median (interquartile range): 5 (1-8) vs 14 (7.5-19.25) days, p<0.001] and shorter duration of respiratory support [10.5 (4-21) vs 18 (11.5-29) days, p=0.03]. There were no differences between groups regarding success of weaning from NCPAP.
  
  
  CONCLUSIONS
  Weaning preterm infants from NCPAP to NC is associated with increased exposure to oxygen and longer duration of respiratory support.
authors.affiliation: Neonatal Care Unit, Mansoura University Children's Hospital, Egypt.
authors.forename: Hesham
authors.initials: H
authors.lastname: Abdel-Hady
authors.forename: Basma
authors.initials: B
authors.lastname: Shouman
authors.forename: Hany
authors.initials: H
authors.lastname: Aly
mesh_terms: D057785:Catheters; D016009:Chi-Square Distribution; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D008297:Male; D010100:Oxygen / Q000008:administration & dosage* / Q000378:metabolism; D013997:Time Factors; D015300:Ventilator Weaning / Q000379:methods*
chemical_list: D010100:Oxygen