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Original research
Extended CPAP or low-flow nasal cannula for intermittent hypoxaemia in preterm infants: a 24-hour randomised clinical trial
  1. Siamak Yazdi1,
  2. Waldemar A Carlo1,
  3. Arie Nakhmani2,
  4. Ernestina O Boateng3,
  5. Immaculada Aban1,
  6. Namasivayam Ambalavanan1,
  7. Colm P Travers1
  1. 1 Department of Pediatrics, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
  2. 2 Department of Electrical and Computer Engineering, University of Alabama at Birmingham, Birmingham, Alabama, USA
  3. 3 Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
  1. Correspondence to Dr Siamak Yazdi; syazdi{at}uabmc.edu

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.

  • Neonatology
  • Intensive Care Units, Neonatal
  • Physiology

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/archdischild-2023-326605

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Contributors SY had primary responsibility for study design, consenting and enrolling patients, acquiring and interpreting data, writing the manuscript, and acting as the guarantor. AN, EOB and IA provided substantial contributions to data analysis and interpretation, as well as drafting and revising the article with regard to these areas and assisting in the creation of tables and figures. CPT, WAC and NA provided substantial contributions to the conception and design of the study, as well as drafting the article and revising it critically for important intellectual content.

    • Funding Supported by the NIH/NHLBI U01HL133536 to NA, the NIH/NHLBI K23HL157618 to CPT and the Dixon Fellowship Training Award to SY.

    • Competing interests NA is on the advisory board for Radiometer, Shire and Resbiotic. CPT has applied for a patent with the USPTO for a bradycardia predictor and interrupter unrelated to the current study.

    • Provenance and peer review Not commissioned; externally peer reviewed.