Jensen CF, et al. - The effect of sudden wean and pressure wean from nasal continuous positive airway pressure (nCPAP) in very preterm infants were compared in this analysis. No difference in weight gain velocity or any of the secondary outcomes between very preterm infants who were randomized to sudden wean or pressure wean from nCPAP was found. Researchers reported that among infants born before 28 weeks’ gestation, infants from the pressure wean group were more often successfully weaned during the first attempt without a longer total duration of nCPAP treatment.

Methods

• It was a randomized, clinical, open-label, multicenter trial.
• This trial was carried out at 6 neonatal intensive care units in Denmark from September 2012 to December 2016 and included infants born before 32 weeks of gestation.
• Sudden wean with discontinuation of nCPAP without a prior reduction in pressure and the pressure wean with gradual pressure reduction prior to the discontinuation of nCPAP were the main interventiions.
• Weight gain velocity from randomization to postmenstrual age 40 weeks was the primary outcome.
• Other measures of growth, nCPAP and the duration of oxygen supplementation, postmenstrual age at successful wean and at discharge, successful wean at the first attempt, the number of attempts to wean, and the length of the hospital stay were the included secondary outcomes.
• Researchers performed prespecified subgroup analyses by gestational age.

Results

• According to the findings obtained, out of 372 randomized infants, 185 (49.7%) were randomized to sudden wean and 187 infants (50.3%) to pressure wean.
• One hundred seventy-seven infants in both groups completed the trial (median gestational age for sudden and pressure wean, 30 weeks [interquartile range, 29-31]; male: sudden wean, 89 [50%]; pressure wean, 96 [54%]).
• No difference in mean [SD] weight gain velocity from randomization to 40 weeks postmenstrual age between the 2 groups (22 [6] g/kg/day) was found.
• In any of the secondary outcomes, no difference was found.
• The study results showed that more infants born before 28 weeks of gestation were successfully weaned from nCPAP during the first attempt in the pressure wean group compared with the sudden wean group (risk difference, 31%; 95% CI, 13%-50%).
• No difference in the duration of nCPAP and oxygen supplementation was found.