Discontinuing Nasal Continuous Positive Airway Pressure in Infants ≤32 Weeks of Gestational Age: A Randomized Control Trial

Kakkilaya, Venkatakrishna; Tang, Anson; Wagner, Sheron; Ridpath, Judy; Ibrahim, John; Brown, L. Steven; Rosenfeld, Charles R.

doi:10.1016/j.jpeds.2020.10.045

Cited by 5 publications

(15 citation statements)

References 37 publications

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“…Our results are in alignment with those of Kakkilaya et al, 12 who reported a median PMA of 31 (30, 32) weeks at successful first trial off nCPAP in infants born at <33 weeks’ gestation. Of note, more infants in the Kakkilaya study were successful at the first trial off nCPAP (57% vs. 43%), which could be explained by the fact that they enrolled infants who were born at higher GA (<33 weeks) compared with infants included in our study (≤29 weeks ‘gestation).…”

Section: Discussionsupporting

confidence: 92%

“…37,38 weeks) and higher weight (1600-1900 g) at successful trial off of nCPAP. 10,12,13,22 In these studies, investigators reported time to come off nCPAP for the whole study population without stratifying according to GA. In contrast, we reported the time of successful trial off respiratory support for our study population as either subgroups (22-24, 25-26, 27-28, and >28 weeks' gestation) or for each GA separately to help care teams in ascertaining the optimal time to try off nCPAP or HFNC.…”

Section: Discussionmentioning

confidence: 99%

“…Kakkilaya et al 12 and Jensen et al 11 performed subgroup analysis to examine the success of weaning off nCPAP based on GA dividing their cohort into two groups: <28 weeks GA and ≥28 weeks GA. Infants born at a higher GA (≥28 weeks’ gestation) were successfully taken off nCPAP at earlier PMA.…”

Section: Discussionmentioning

confidence: 99%

“…Further, two systematic reviews that aimed to address this issue have shown a higher mean PMA of 32–33 weeks and mean weight of 1600–1770 g at the time of successful trial off nCPAP 37,38 . Similarly, several randomized control trials have shown higher mean PMA (32–35 weeks) and higher weight (1600–1900 g) at successful trial off of nCPAP 10,12,13,22 . In these studies, investigators reported time to come off nCPAP for the whole study population without stratifying according to GA.…”

Section: Discussionmentioning

confidence: 99%

“…incidence of bronchopulmonary dysplasia associated with invasive ventilation. [7][8][9] With the aim of optimizing successful transition off nCPAP support, many different strategies have been studied including gradual pressure decrease, [10][11][12] transition to a lesser form of respiratory support, [13][14][15][16] and time cycling 13,[17][18][19][20][21][22] compared with sudden complete discontinuation. In a systematic review to identify the optimal weaning method, gradual pressure weaning increased the likelihood of successful first trial off nCPAP but at a later postmenstrual age (PMA).…”

mentioning

confidence: 99%

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Predictors of successful trial off continuous positive airway pressure and high flow nasal cannula in preterm infants <30 weeks' gestation: A retrospective study

Mohsen

Nasef

Elkhouli

et al. 2022

Pediatric Pulmonology

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Objectives: To identify the predictors of successful first trial off nasal continuous positive airway pressure (nCPAP).Methods: A retrospective cohort study of infants ≤29 weeks' gestation who required nCPAP for >24 h was conducted. Logistic regression was used to detect predictors for successful trial off nCPAP. Statistical analysis was performed using the SAS software.Results: A total of 727 infants were included in the analysis. Infants who were successful in their first trial off nCPAP (n = 313) were of higher gestational age (GA) and birth weight (BW), as well as a higher proportion of female infants, compared with those who were not successful (p < 0.01). When stratified by GA, a negative correlation was noted between GA and postmenstrual age at successful trial off nCPAP or high flow nasal cannula (HFNC) (r = 0.45, p < 0.01). Logistic regression analysis showed that GA (odds ratio [OR] 1.13, 95% confidence interval [CI] [1.03-1.24], p = 0.01) and percentage of time spent with an oxygen saturation over 89% in the 24 h preceding the trial off nCPAP (OR 1.08,], p = 0.00) were independent predictors for successful trial off nCPAP. Conclusion:Successful trial off nCPAP or HFNC in preterm infants is significantly associated with higher GA, BW, female gender, and the specific oxygen saturation histogram in the preceding 24-h period.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Predictors of successful trial off continuous positive airway pressure and high flow nasal cannula in preterm infants <30 weeks' gestation: A retrospective study

Mohsen

Nasef

Elkhouli

et al. 2022

Pediatric Pulmonology

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Race and Ethnicity of Infants Enrolled in Neonatal Clinical Trials

Lyle,

Shaikh,

Oslin

et al. 2023

JAMA Netw Open

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ImportanceRepresentativeness of populations within neonatal clinical trials is crucial to moving the field forward. Although racial and ethnic disparities in research inclusion are well documented in other fields, they are poorly described within neonatology.ObjectiveTo describe the race and ethnicity of infants included in a sample of recent US neonatal clinical trials and the variability in this reporting.Evidence ReviewA systematic search of US neonatal clinical trials entered into Cochrane CENTRAL 2017 to 2021 was conducted. Two individuals performed inclusion determination, data extraction, and quality assessment independently with discrepancies adjudicated by consensus.FindingsOf 120 studies with 14 479 participants that met the inclusion criteria, 75 (62.5%) included any participant race or ethnicity data. In the studies that reported race and ethnicity, the median (IQR) percentage of participants of each background were 0% (0%-1%) Asian, 26% (9%-42%) Black, 3% (0%-12%) Hispanic, 0% (0%-0%) Indigenous (eg, Alaska Native, American Indian, and Native Hawaiian), 0% (0%-0%) multiple races, 57% (30%-68%) White, and 7% (1%-21%) other race or ethnicity. Asian, Black, Hispanic, and Indigenous participants were underrepresented, while White participants were overrepresented compared with a reference sample of the US clinical neonatal intensive care unit (NICU) population from the Vermont Oxford Network. Many participants were labeled as other race or ethnicity without adequate description. There was substantial variability in terms and methods of reporting race and ethnicity data. Geographic representation was heavily skewed toward the Northeast, with nearly one-quarter of states unrepresented.Conclusions and RelevanceThese findings suggest that neonatal research may perpetuate inequities by underrepresenting Asian, Black, Hispanic, and Indigenous neonates in clinical trials. Studies varied in documentation of race and ethnicity, and there was regional variation in the sites included. Based on these findings, funders and clinical trialists are advised to consider a 3-point targeted approach to address these issues: prioritize identifying ways to increase diversity in neonatal clinical trial participation, agree on a standardized method to report race and ethnicity among neonatal clinical trial participants, and prioritize the inclusion of participants from all regions of the US in neonatal clinical trials.

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EBNEO commentary: Weaning from CPAP using high‐flow is non‐inferior to using CPAP alone in very preterm infants

2023

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Continuous positive airway pressure (nCPAP) is widely used in neonatal units both as a primary mode of non-invasive respiratory support and post-extubation. 1 Despite increased uptake of non-invasive ventilation, time on oxygen therapy and oxygen requirement at 36 weeks CGA is higher than before. 2 In contrast to mechanical ven-How to cite this article: Ezeh NI, Eyo TJ, Gurusamy K. EBNEO commentary: Weaning from CPAP using high-flow is non-inferior to using CPAP alone in very preterm infants. Acta

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Discontinuing Nasal Continuous Positive Airway Pressure in Infants ≤32 Weeks of Gestational Age: A Randomized Control Trial

Cited by 5 publications

References 37 publications

Predictors of successful trial off continuous positive airway pressure and high flow nasal cannula in preterm infants <30 weeks' gestation: A retrospective study

Predictors of successful trial off continuous positive airway pressure and high flow nasal cannula in preterm infants <30 weeks' gestation: A retrospective study

Race and Ethnicity of Infants Enrolled in Neonatal Clinical Trials

EBNEO commentary: Weaning from CPAP using high‐flow is non‐inferior to using CPAP alone in very preterm infants

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