Pressure versus Sudden Wean from Nasal Continuous Positive Airway Pressure in Preterm Infants: A Systematic Review and Meta-Analysis.

Abstract:

BACKGROUND:Nasal continuous positive airway pressure (NCPAP) is a well-studied treatment for respiratory problems in preterm infants. However, the best strategy for NCPAP weaning is unknown. OBJECTIVE:We aimed to compare the success of progressive pressure wean versus sudden wean for discontinuation of NCPAP in preterm infants. METHODS:We conducted a systematic review and meta-analysis of publications identified by searching MEDLINE, Embase, -CINAHL, and CENTRAL. Randomized controlled trials comparing pressure wean to sudden wean for NCPAP in preterm infants were included. Primary outcomes were postmenstrual age (PMA) at successful weaning and weight gain. Secondary outcomes were total duration of ventilation, success of weaning strategy on first attempt, length of stay (LOS), and bronchopulmonary dysplasia (BPD). RESULTS:Two trials (422 infants) were eligible for inclusion. Pressure wean was associated with a higher PMA at weaning (33.9 ± 2.1 vs. 32.1 ± 2.0 weeks, mean difference [MD] 0.88, 95% CI 0.40 to 1.35, low quality evidence). Daily weight gain was only reported in 1 trial. Total duration of ventilation was not reported. Pressure wean was associated with higher probability of successful weaning at first attempt (risk ratio [RR] 1.25, 95% CI 1.03-1.53). However, it was not associated with LOS (MD -2.5 days, 95% CI -7.3 to 2.4) or BPD (RR 0.92, 95% CI 0.52-1.63). CONCLUSION:Sudden wean of NCPAP was associated with a lower PMA at successful wean compared to pressure wean but also with a lower rate of successful wean at first attempt, most likely because of the developmental stage at which weaning is possible.

journal_name

Neonatology

journal_title

Neonatology

authors

Lemieux-Bourque C,Piedboeuf B,Fontela PS,Bornais K,Beltempo M

doi

10.1159/000507863

subject

Has Abstract

pub_date

2020-01-01 00:00:00

pages

537-544

issue

5

eissn

1661-7800

issn

1661-7819

pii

000507863

journal_volume

117

pub_type

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