title: Strategies for the withdrawal of nasal continuous positive airway pressure (NCPAP) in preterm infants.
abstract: BACKGROUND
  While indications for the use of nasal continuous positive airway pressure (NCPAP) and its associated risks and benefits are extensively investigated, the best strategy for the withdrawal of NCPAP remains unknown. In a survey of Australian and New Zealand Neonatologists, 56% stated that their approach to NCPAP weaning was "ad hoc" (Jardine 2008). At what point an infant is considered stable enough to attempt to start withdrawing their NCPAP is not clearly established. The criteria for a failed attempt at NCPAP withdrawal is also not clear.
  
  
  OBJECTIVE
  To determine the risks and benefits of different strategies used for the withdrawal of NCPAP in preterm infants.
  
  
  METHODS
  Searches were made of the Cochrane Neonatal Review Group Specialised Register, MEDLINE from 1966 to June 2010, CINAHL from 1982 to June 2010, and the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2010, Issue 2). Previous reviews (including cross references) were also searched.
  
  
  METHODS
  We included all randomised and quasi-randomised controlled trials in which either individual newborn infants or clusters of infants (such as separate neonatal units) were randomised to different NCPAP withdrawal strategies (from the first time they come off NCPAP and any subsequent weaning and/or withdrawal attempt).
  
  
  METHODS
  We used standard methods of The Cochrane Collaboration and its Neonatal Review Group.
  
  
  RESULTS
  We identified four potentially eligible studies. Three studies are included in this review. One study showed a significant decrease in the duration of oxygen therapy and a significantly decreased length of stay for babies randomised to a weaning strategy where NCPAP is simply stopped when infants met predefined stability criteria.
  
  
  CONCLUSIONS
  Infants who have their NCPAP pressure weaned to a predefined level and then stop NCPAP completely have less total time on NCPAP and shorter durations of oxygen therapy and hospital stay compared with those that have NCPAP removed for a predetermined number of hours each day. Future trials of withdrawing NCPAP should compare proposed strategies with weaning NCPAP pressure to a predefined level and then stopping NCPAP completely. Clear criteria need to be established for the definition of stability prior to attempting to withdraw NCPAP.
authors.affiliation: Department of Neonatology, Mater Mother's Hospital, Mater Medical Research Institute, The University of Queensland, Raymond Terrace, South Brisbane, Queensland, Australia, 4101.
authors.forename: Luke A
authors.initials: LA
authors.lastname: Jardine
authors.forename: Garry Dt
authors.initials: GD
authors.lastname: Inglis
authors.forename: Mark W
authors.initials: MW
authors.lastname: Davies
mesh_terms: D045422:Continuous Positive Airway Pressure; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007902:Length of Stay; D010102:Oxygen Inhalation Therapy; D016032:Randomized Controlled Trials as Topic; D015300:Ventilator Weaning / Q000379:methods* / Q000592:standards