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J Pediatr. 2014 Jan;164(1):46-51. doi: 10.1016/j.jpeds.2013.08.040. Epub 2013 Oct 1.

A randomized controlled trial of two nasal continuous positive airway pressure levels after extubation in preterm infants.

Author information

1
Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL.
2
Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL. Electronic address: nclaure@miami.edu.

Abstract

OBJECTIVE:

To compare extubation failure rate with two ranges of nasal continuous positive airway pressure (NCPAP) in oxygen dependent preterm infants.

STUDY DESIGN:

Preterm infants of birth weight 500-1000 g and gestational age 23-30 weeks, extubated for the first time during the first 6 weeks while requiring fraction of inspired oxygen ≥ 0.25, were randomly assigned to a NCPAP range of 4-6 (low NCPAP) or 7-9 (high NCPAP) cmH2O.

RESULTS:

Infants were randomized to low (n = 47) or high NCPAP (n = 46) at day 16.3 ± 14.7 and 15.5 ± 12.4, respectively. Rates of extubation failure per criteria (24% vs 43%, P = .04, OR and 95% CI: 0.39 [0.16-0.96]) and re-intubation (17% vs 38%, P = .023, 0.33 [0.016-0.85]) within 96 hours were significantly lower in the high- compared with the low NCPAP group. This was mainly due to a strikingly lower failure rate in the 500-750 g birth weight strata. Duration of ventilation, bronchopulmonary dysplasia, or severe bronchopulmonary dysplasia did not differ significantly. No infant developed pneumothorax during 96 hours post-extubation.

CONCLUSIONS:

Extubation failure in preterm infants with residual lung disease was lower with NCPAP range of 7-9 compared with 4-6 cmH2O. These findings suggest the need for higher distending pressure post-extubation in the more immature infants who are still oxygen dependent.

KEYWORDS:

BPD; BW; Birth weight; Bronchopulmonary dysplasia; FiO(2); Fraction of inspired oxygen; GA; Gestational age; NCPAP; NICU; Nasal continuous positive airway pressure; Neonatal intensive care unit; PDA; PMA; Patent ductus arteriosus; Post-menstrual age

PMID:
24094879
DOI:
10.1016/j.jpeds.2013.08.040
[Indexed for MEDLINE]

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