title: Randomised controlled trial of weaning strategies for preterm infants on nasal continuous positive airway pressure.
abstract: BACKGROUND
  The optimal strategy for weaning very preterm infants from nasal continuous positive airway pressure (NCPAP) is unclear. Reported strategies include weaning NCPAP to a predefined pressure then trialling stopping completely (abrupt wean); alternate periods of increased time off NCPAP whilst reducing time on until the infant is completely weaned (gradual wean); and using high flow nasal cannula (HFNC) to assist the weaning process. The aim of this study was to determine the optimal weaning from NCPAP strategy for very preterm infants.
  
  
  METHODS
  A pilot single centre, factorial design, 4-arm randomised controlled trial. Sixty infants born <30 weeks gestation meeting stability criteria on NCPAP were randomly allocated to one of four groups. Group 1: abrupt wean with HFNC; Group 2: abrupt wean without HFNC; Group 3: gradual wean with HFNC; Group 4: gradual wean without HFNC. The primary outcomes were duration of respiratory support, chronic lung disease, length of hospital stay and time to full suck feeds.
  
  
  RESULTS
  The primary outcome measures were not significantly different between groups. Group 1 had a significant reduction in duration of NCPAP (group 1: median 1 day; group 2: 24 days; group 3: 15 days; group 4: 24 days; p = 0.002) and earlier corrected gestational age off NCPAP. There was a significant difference in rate of parental withdrawal from the study, with group 2 having the highest rate. Group 3 had a significantly increased duration on HFNC compared to group 1.
  
  
  CONCLUSIONS
  Use of high flow nasal cannula may be effective at weaning infants from NCPAP but did not reduce duration of respiratory support or time to full suck feeds. Abrupt wean without the use of HFNC was associated with an increased rate of withdrawal by parent request.
  
  
  BACKGROUND
  This study is registered at the Australian New Zealand Clinical Trials Registry ( www.anzctr.org.au/). (Registration Number =  ACTRN12610001003066).
authors.affiliation: University of Melbourne, Melbourne, Australia. j.tang114@gmail.com.
authors.forename: Jessica
authors.initials: J
authors.lastname: Tang
authors.affiliation: RPA Newborn Care, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney, NSW 2050, Australia. Shelley.Reid@sswahs.nsw.gov.au.|Faculty of Nursing and Midwifery, University of Sydney, Sydney, NSW 2006, Australia. Shelley.Reid@sswahs.nsw.gov.au.
authors.forename: Shelley
authors.initials: S
authors.lastname: Reid
authors.affiliation: Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, NSW 2006, Australia. tracey.lutz@sswahs.nsw.gov.au.
authors.forename: Tracey
authors.initials: T
authors.lastname: Lutz
authors.affiliation: Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, NSW 2006, Australia. girvan.malcolm@sswahs.nsw.gov.au.
authors.forename: Girvan
authors.initials: G
authors.lastname: Malcolm
authors.affiliation: RPA Newborn Care, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney, NSW 2050, Australia. sue.oliver@live.com.
authors.forename: Sue
authors.initials: S
authors.lastname: Oliver
authors.affiliation: RPA Newborn Care, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney, NSW 2050, Australia. david.osborn@sydney.edu.au.|Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, NSW 2006, Australia. david.osborn@sydney.edu.au.
authors.forename: David Andrew
authors.initials: DA
authors.lastname: Osborn
mesh_terms: D045422:Continuous Positive Airway Pressure; D005247:Feeding Behavior; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007902:Length of Stay; D008297:Male; D010865:Pilot Projects; D013997:Time Factors; D015300:Ventilator Weaning / Q000379:methods*