title: Weaning preterm infants from continuous positive airway pressure: evidence for best practice.
abstract: BACKGROUND
  Nasal continuous positive airway pressure (NCPAP) is frequently used in preterm infants. However, there is no consensus on when and how to wean them from NCPAP.
  
  
  METHODS
  Based on recent publications, we have reviewed the criteria of readiness-to-wean and factors affecting weaning success. A special focus is placed on the methods of weaning from NCPAP in preterm infants.
  
  
  RESULTS
  Practical points of when and how to wean from NCPAP in preterm infants are explained. Preterm infants are ready to be weaned from NCPAP when they are stable on a low NCPAP pressure with no (or minimal) oxygen requirement. Methods used to wean from NCPAP include: sudden weaning of NCPAP, gradual decrease of NCPAP pressure, graded-timeoff NCPAP (cycling), weaning to high or low flow nasal cannula, and a combination of these methods. The best strategy for weaning is yet to be determined. Cyclingoff NCPAP increases the duration of NCPAP and length of hospital stay without beneficial effect on success of weaning. Gradual decrease of NCPAP pressure is more physiological and better tolerated than cycling-off NCPAP.
  
  
  CONCLUSIONS
  Further studies are needed to reach a consensus regarding the optimal timing and the best method for weaning from NCPAP in preterm infants.
authors.affiliation: Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt, hehady@yahoo.com.
authors.forename: Hesham
authors.initials: H
authors.lastname: Abdel-Hady
authors.forename: Basma
authors.initials: B
authors.lastname: Shouman
authors.forename: Nehad
authors.initials: N
authors.lastname: Nasef
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000379:methods*; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D008297:Male; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000628:therapy*; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000009:adverse effects / Q000379:methods*
references.citation: J Perinatol. 2007 Feb;27(2):85-91
references.pmid: 17262040
references.citation: Arch Dis Child Fetal Neonatal Ed. 2005 Jan;90(1):F92-3
references.pmid: 15613590
references.citation: Cochrane Database Syst Rev. 2011 Feb 16;(2):CD006979
references.pmid: 21328289
references.citation: Eur J Pediatr. 2012 Oct;171(10):1441-8
references.pmid: 22173399
references.citation: N Engl J Med. 2013 Oct 10;369(15):1425-33
references.pmid: 24106935
references.citation: Pediatrics. 1987 Jan;79(1):26-30
references.pmid: 3797169
references.citation: Arch Otolaryngol Head Neck Surg. 2010 Mar;136(3):287-91
references.pmid: 20231649
references.citation: J Paediatr Child Health. 2014 Oct;50(10):806-10
references.pmid: 24943729
references.citation: J Perinatol. 2005 Jul;25(7):453-8
references.pmid: 15858606
references.citation: Respir Med. 2009 Oct;103(10):1400-5
references.pmid: 19467849
references.citation: Neonatology. 2012;102(4):300-8
references.pmid: 22964658
references.citation: Biol Neonate. 1999 Sep;76(3):129-33
references.pmid: 10460950
references.citation: Biol Neonate. 1976;29(3-4):178-86
references.pmid: 782570
references.citation: J Paediatr Child Health. 2015 Feb;51(2):199-203
references.pmid: 25039700
references.citation: Eur J Pediatr. 2014 Jan;173(1):93-8
references.pmid: 23942744
references.citation: Arch Dis Child Fetal Neonatal Ed. 2014 Sep;99(5):F423-5
references.pmid: 24812104
references.citation: Arch Dis Child Fetal Neonatal Ed. 2003 May;88(3):F168-72
references.pmid: 12719386
references.citation: Am Rev Respir Dis. 1990 Dec;142(6 Pt 1):1288-93
references.pmid: 2252246
references.citation: ASAIO J. 2002 Sep-Oct;48(5):476-9
references.pmid: 12296565
references.citation: Pediatrics. 2001 May;107(5):1081-3
references.pmid: 11331690
references.citation: Pediatr Res. 1978 Jul;12(7):771-4
references.pmid: 358112
references.citation: J Paediatr Child Health. 2012 Feb;48(2):106-13
references.pmid: 21470336
references.citation: J Pediatr. 2009 Feb;154(2):177-82
references.pmid: 18760803
references.citation: J Perinatol. 2006 Aug;26(8):476-80
references.pmid: 16688202
references.citation: Pediatr Pulmonol. 1991;11(3):259-64
references.pmid: 1758748
references.citation: Early Hum Dev. 2012 May;88 Suppl 2:S81-3
references.pmid: 22633522
references.citation: Arch Dis Child Fetal Neonatal Ed. 2012 Jul;97(4):F236-40
references.pmid: 22611116
references.citation: Pediatrics. 2013 Mar;131(3):e939-44
references.pmid: 23382446
references.citation: Pediatr Pulmonol. 2011 Jan;46(1):67-74
references.pmid: 21171186
references.citation: Semin Fetal Neonatal Med. 2009 Feb;14(1):14-20
references.pmid: 18835546
references.citation: Am J Gastroenterol. 2008 Mar;103(3):720-8
references.pmid: 18341491
references.citation: Pediatrics. 2009 Jun;123(6):1562-73
references.pmid: 19482769
references.citation: Pediatrics. 2008 Nov;122(5):e1086-90
references.pmid: 18977958
references.citation: Cochrane Database Syst Rev. 2011 May 11;(5):CD006405
references.pmid: 21563154
references.citation: Pediatrics. 2005 Nov;116(5):1216-7
references.pmid: 16264009
references.citation: Adv Neonatal Care. 2008 Apr;8(2):78-95; quiz 96-7
references.pmid: 18418205
references.citation: J Perinatol. 2008 Nov;28(11):779-81
references.pmid: 18974751
references.citation: Early Hum Dev. 2011 Mar;87(3):205-8
references.pmid: 21276671
references.citation: Arch Dis Child Fetal Neonatal Ed. 2014 Mar;99(2):F134-7
references.pmid: 24225220
references.citation: Chron Respir Dis. 2008;5(2):81-6
references.pmid: 18539721
references.citation: Adv Neonatal Care. 2008 Apr;8(2):98-106
references.pmid: 18418207
references.citation: Respir Care. 2009 Sep;54(9):1209-35
references.pmid: 19712498
references.citation: N Engl J Med. 2008 Feb 14;358(7):700-8
references.pmid: 18272893
references.citation: Pediatrics. 2008 Jan;121(1):82-8
references.pmid: 18166560
references.citation: Pediatr Int. 2010 Dec;52(6):893-4
references.pmid: 21166951
references.citation: Respir Care. 2013 Mar;58(3):511-6
references.pmid: 22906960
references.citation: Pediatrics. 2013 May;131(5):e1482-90
references.pmid: 23610207
references.citation: Pediatrics. 2000 Jun;105(6):1194-201
references.pmid: 10835057
references.citation: Pediatrics. 2009 Aug;124(2):786-9
references.pmid: 19651592
references.citation: Pediatr Pulmonol. 2009 Jul;44(7):629-34
references.pmid: 19499590
references.citation: J Pediatr. 2013 May;162(5):949-54.e1
references.pmid: 23260098
references.citation: Pediatrics. 1993 Jan;91(1):135-8
references.pmid: 8416477
references.citation: J Pediatr. 1991 Mar;118(3):443-5
references.pmid: 1999789
references.citation: Arch Dis Child Fetal Neonatal Ed. 2005 Nov;90(6):F480-3
references.pmid: 15941825
references.citation: Adv Neonatal Care. 2008 Apr;8(2):116-24
references.pmid: 18418209
references.citation: Curr Gastroenterol Rep. 2007 Jun;9(3):219-24
references.pmid: 17511920
references.citation: Int J Pediatr. 2012;2012:416073
references.pmid: 22187570
references.citation: J Paediatr Child Health. 2012 Jan;48(1):16-21
references.pmid: 21988616
references.citation: Chest. 1994 Apr;105(4):1061-5
references.pmid: 8162725
references.citation: J Appl Physiol (1985). 1987 Jan;62(1):170-4
references.pmid: 3558177
references.citation: Semin Neonatol. 2002 Oct;7(5):379-89
references.pmid: 12464500
references.citation: Arch Dis Child Fetal Neonatal Ed. 2010 Nov;95(6):F447-51
references.pmid: 20584802
references.citation: J Pediatr. 2013 Jul;163(1):79-83
references.pmid: 23312683
references.citation: Arch Dis Child Fetal Neonatal Ed. 2014 Jul;99(4):F315-20
references.pmid: 24786469
references.citation: J Pediatr. 1985 Jan;106(1):91-4
references.pmid: 3917503
references.citation: Pediatr Int. 2008 Aug;50(4):572-5
references.pmid: 19143985