A Comparison of Methods of Discontinuing Nasal CPAP in Premature Infants <30 Weeks Gestation

Not Applicable

Completed

Interventions: Device: Discontinue NCPAP after weaning pressures
Device: Discontinue NCPAP without weaning pressures

Brief Summary: The purpose of this study is to determine if among infants \<30 weeks gestational age on nasal continuous positive airway pressure (NCPAP), whether discontinuing CPAP after gradual reduction in continuous positive airway pressure (CPAP) pressure leads to successful weaning off CPAP when compared to discontinuing CPAP without weaning pressure.

Recruitment & Eligibility

Inclusion Criteria

All infants < 30 weeks by dates, on NCPAP therapy, on caffeine 10mg/kg daily
Meet CPAP stability criteria for ≥ 12hours (CPAP 6 cm water (H2O), FiO2 </=0.25 and stable (to maintain sats 85-95%), Respiratory rate consistently less than 60, Mild to no subcostal/intercostal retractions, No Apnea or bradycardia event that requires bag mask ventilation, Less than 3 apnea/brady/desat episodes in any 1 hour period for previous 6 hours, Tolerated time off CPAP during routine CPAP care (~15 min)

Exclusion Criteria

Arm && Interventions

Group	Intervention	Description
Discontinue NCPAP after weaning pressures	Discontinue NCPAP after weaning pressures	After randomization, CPAP pressure will be weaned by 1 every 24hours as long as the subjects continue to meet stability criteria after each wean, until CPAP of 4. If after decrease in CPAP pressure, the subject meets CPAP failure criteria pressure will be increased back to the previous level and after stabilization for 24 hours weaning process will be started again. Once the subject meets stability criteria on CPAP of 4, NCPAP will be stopped and subject will be placed on nasal cannula (NC) according to unit guidelines (max 1 Liter flow, 30% FiO2).
Discontinue NCPAP without weaning pressures	Discontinue NCPAP without weaning pressures	After randomization, once the subject meets stability criteria, NCPAP will be stopped and subject will be placed on nasal cannula (NC) according to unit guidelines (max 1 Liter flow, 30% FiO2).

Primary Outcome Measures

Name	Time	Method
Number of Days on NCPAP or Mechanical Ventilation	from randomization until 28 days post-randomization	Subjects might go on and off NCPAP or mechanical ventilation throughout the 28 days after randomization, and the total number of days will be reported.

Secondary Outcome Measures

Name	Time	Method
Number of Participants Who Failed to Wean Off NCPAP	from randomization until discharge (about 92 days)
Duration of Endotracheal Ventilation	from randomization until 28 days post-randomization	Subjects might go on and off endotracheal ventilation throughout the 28 days after randomization, and the total number of days will be reported.
Length of Hospital Stay	from admission to hospital until discharge (about 92 days)
Number of Participants Who Developed Necrotizing Enterocolitis	from randomization until discharge (about 92 days)
Number of Days of Life at Which Infant Starting Taking All Feeds by Mouth	from randomization until discharge (about 92 days)
Number of Participants Who Developed Bronchopulmonary Dysplasia	from randomization until discharge (about 92 days)
Number of Participants Who Developed Air Leak Disorders	from randomization until discharge (about 92 days)	Air leak disorders include pneumothorax, pneumomediastinum, and pulmonary interstitial emphysema.