Randomized, controlled trial of nasopharyngeal continuous positive airway pressure in the extubation of very low birth weight infants,☆☆,,★★

Presented at the 1993 annual meetings of the Southern Society for Pediatric Research (Jan. 21-23) and the Society for Pediatric Research (May 3-6).
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Abstract

We conducted a prospective, randomized controlled trial to determine whether extubation of very low birth weight infants was facilitated by the use of nasopharyngeal continuous positive airway pressure (CPAP). Eligible infants included patients weighing 600 to 1500 gm at birth who required tracheal intubation within 48 hours of birth and who met specific predetermined criteria for extubation by day 14 of life. We also sought to determine whether varying the duration of nasopharyngeal CPAP influenced the likelihood of successful extubation. Infants underwent random assignment to receive nasopharyngeal CPAP until resolution of lung disease (n = 40), 6 hours of nasopharyngeal CPAP (n = 42), or oxygen supplementation delivered by hood (n = 42). Extubation failure was predefined as a requirement for ≥80% oxygen, pH ≤7.20, severe apnea, or predefined clinical deterioration, and extubation success was predefined as the ability to remain free of a requirement for mechanical ventilation for 7 days and a 66% reduction in the need for supplemental oxygen. Each group was similar with regard to race, sex, and birth weight. Extubation was successful in 62%, 61%, and 60% of infants. After stratification by birth weight, there were no significant differences in the rates of successful extubation among the treatment groups. We conclude that nasopharyngeal CPAP does not improve the likelihood of successful extubation of very low birth weight infants who are ready for extubation within the first 2 weeks of life. (J Pediatr 1994;124:455-60)

Section snippets

METHODS

We sought to investigate the hypothesis under the conditions usually encountered in intensive care nurseries (management trial design). For this reason the study design allowed for a defined degree of clinical decision making by the patient care team. Clinical examinations that are not widely available in level 3 nurseries, such as preextubation pulmonary function testing, were not used.

All inborn and transferred infants admitted to the neonatal intensive care unit at the Medical University of

RESULTS

From Aug. 2, 1990, through Aug. 3, 1992, a total of 216 potentially eligible infants were admitted to the neonatal intensive care unit. Of these, 126 were enrolled in our study and randomly assigned to a treatment group. The remaining 90 infants born during the study period were not enrolled for the following reasons: presence of congenital anomalies, 4; inability to obtain consent or consent refused, 18; infant death before eligibility, 31 (including 2 infants for whom a decision not to

DISCUSSION

Beneficial effects of CPAP on the clinical courses of patients with respiratory diseases and its effects on obstructive and mixed apnea are well known.1, 2, 3, 4, 5, 6, 7, 8, 10, 12, 15, 16 These clinical observations, supported by measurable effects on pulmonary function and mechanics that indicate the prevention of atelectasis, recruitment of small airways, increased airway diameter, and improved reflex-mediated respiratory responses,6, 7, 11, 15, 17 suggest a therapeutic role in the support

References (18)

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From the Department of Pediatrics, Medical University of South Carolina, Charleston

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Supported in part by the South Carolina American Lung Association.

Reprint requests: David J. Annibale, MD, Department of Pediatrics, Medical University of South Carolina, 171 Ashley Ave., Charleston, SC 29425.

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