Elective use of nasal continuous positive airways pressure following extubation of preterm infants

The aim of this study was to determine whether elective use of nasal contin uous positive airways pressure (CPAP) following extubation of preterm infan ts was well tolerated and improved short- and long-term outcomes. A randomi zed comparison of nasal CPAP to headbox oxygen was undertaken and a meta-an alysis performed including similar randomized trials involving premature in fants less than 28 days of age. A total of 150 infants (median gestational age 30 weeks, range 24-34 weeks) were randomized in two centres. Fifteen na sal CPAP infants and 25 headbox infants required increased respiratory supp ort post-extubation and 15 nasal CPAP infants and nine headbox infants requ ired reintubation (non significant). Eight infants became intolerant of CPA P and were changed to headbox oxygen within 48 h of extubation; 19 headbox infants developed apnoeas and respiratory acidosis requiring rescue nasal C PAP, 3 ultimately were re-intubated. Seven other trials were identified. gi ving a total number of 569 infants. Overall, nasal CPAP significantly reduc ed the need for increased respiratory support (relative risk, 0.57, 95% CI 0.43-0.73), but not for re-intubation (relative risk 0.89. 95% CI 0.68-1.17 ). Nasal CPAP neither influenced significantly the intraventricular haemorr hage rate reported in four studies (relative risk 1.0, 95% CI 0.55, 1.82) n or that of oxygen dependency at 28 days reported in six studies (relative r isk 1.0, 95% CI 0.8, 1.25). In two studies nasal CPAP had to be discontinue d in 10% of infants either because of intolerance or hyperoxia. Conclusion Elective use of nasal continuous positive airways pressure post- extubation is not universally tolerated, but does reduce the need for addit ional support.