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

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.