Extended CPAP or low-flow nasal cannula for intermittent hypoxaemia in preterm infants: a 24-hour randomised clinical trial.
Arch Dis Child Fetal Neonatal Ed
; 109(5): 557-561, 2024 Aug 16.
Article
em En
| MEDLINE
| ID: mdl-38365446
ABSTRACT
OBJECTIVE:
Optimal timing of continuous positive airway pressure (CPAP) cessation in preterm infants remains undetermined. We hypothesised that CPAP extension compared with weaning to low-flow nasal cannula (NC) reduces intermittent hypoxaemia (IH) and respiratory instability in preterm infants meeting criteria to discontinue CPAP.DESIGN:
Single-centre randomised clinical trial.SETTING:
Level 4 neonatal intensive care unit. PATIENTS 36 infants <34 weeks' gestation receiving CPAP≤5 cmH2O and fraction of inspired oxygen (FiO2) ≤0.30 and meeting respiratory stability criteria.INTERVENTIONS:
Extended CPAP was compared with weaning to low-flow NC (0.5 L/kg/min with a limit of 1.0 L/min) for 24 hours.OUTCOMES:
The primary outcome was IH (number of episodes with SpO2<85% lasting ≥10 s). Secondary outcomes included coefficient of variability of SpO2, proportion of time in various SpO2 ranges, episodes (≥10 s) with SpO2<80%, median cerebral and renal oxygenation, median effective FiO2, median transcutaneous carbon dioxide and bradycardia (<100/min for≥10 s).RESULTS:
The median (IQR) episodes of IH per 24-hour period was 20 (6-48) in the CPAP group and 76 (18-101) in the NC group (p=0.03). Infants continued on CPAP had less bradycardia, time with SpO2 <91% and <85%, and lower FiO2 (all p<0.05). There were no statistically significant differences in IH<80%, median transcutaneous carbon dioxide or median cerebral or renal oxygenation.CONCLUSION:
In preterm infants meeting respiratory stability criteria for CPAP cessation, extended CPAP decreased IH, bradycardia and other hypoxaemia measures compared with weaning to low-flow NC during the 24-hour intervention. TRIAL REGISTRATION NUMBER NCT04792099.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Recém-Nascido Prematuro
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Pressão Positiva Contínua nas Vias Aéreas
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Cânula
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Hipóxia
Limite:
Female
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Humans
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Male
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Newborn
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article