Higher nasal CPAP helps avoid extubation failure in extremely preterm infants

Extubation with higher levels of nasal continuous positive airway pressure (nCPAP) in preterm infants leads to a lower incidence of extubation failure compared with standard nCPAP levels, without compromising safety, according to a study.

The analysis included 138 infants (51 percent girls, mean birthweight 777 grams) born at less than 28 weeks of gestation (mean gestation age 25.7 weeks), were receiving mechanical ventilation via an endotracheal tube, and were being extubated for the first time to nCPAP. All infants had received prior treatment with exogenous surfactant and caffeine.

The infants were randomly assigned to the higher nCPAP group (n=69) or the standard nCPAP group (n=69). The higher and standard nCPAP groups were maintained within 9–11 and 6–8 cmH₂O, respectively, for at least 24 hours following extubation.

Extubation failure within 7 days, the primary endpoint, occurred less frequently in the higher than in the standard nCPAP group (35 percent vs 57 percent; risk difference, –21.7 percent, 95 percent confidence interval [CI], –38.5 percent to –3.7 percent).

The rates of adverse events during the primary outcome period did not significantly differ between the two groups. Three infants died, including two in the higher nCPAP group and one in the standard nCPAP group. One infant in each group had pneumothorax, and three (two in the higher and one in the standard nCPAP group) had spontaneous intestinal perforation. None of the infants had pulmonary interstitial emphysema.

Larger studies to confirm the present data.