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Ceasing CPAP at Standard Criteria (Cicada): Why Infants Fail to Come Off CPAP Immediately

Presented as a poster at the Neonatal Society 2013 Summer Meeting.

Todd DA1,2, Yin Y1, Wright A3, Broom M2, Hovey D4, Mohammed A-L1,2, Shadbolt B1,5

1 Australian National University Medical School, Woden, ACT, Australia
2 Dept Neonatology, Canberra Hospital, Garran, ACT, Australia
3 Centre for Newborn Care, Westmead Hospital, NSW, Australia
4 Grantley Stable NICU, Royal Brisbane & Women’s Hospital, QLD, Australia
5 Centre for Advances in Epidemiology & IT, Canberra Hospital Garran, ACT, Australia

Background: We showed in a multicentre RCT (1) that CeasIng CPAP at standara criteria (CICADA) compared to cycling off CPAP significantly reduced CPAP weaning time, CPAP time, oxygen requirement, CLD and length of admission. However, some of the premature babies (PBs) using CICADA came off CPAP after 1 or 2 attempts while others required ≥3 attempts. These PBs with ≥3 attempts to come off CPAP had significantly longer CPAP time, and longer oxygen requirements.

Methods: This retrospective analysis of the PBs using the CICADA method in the multicentre RCT (1) of PBs <30 weeks gestation compared the diagnosis and outcomes of those who came off in 1-2 attempts (fast group) and those that required ≥3 attempts to come off (slow group).

Results: 177 PBs were recruited from April 2006 to October 2009 (1), 50 PBs who ceased CPAP using the CICADA method completed the trial. The 26 PBs in the “fast group” had a significantly higher gestational age (GA) and birthweight (BWt), significantly shorter mechanical ventilation (MV), significantly fewer had a patent ductus arteriosus (PDA) compared to the 24 in the “slow group” (table). The “fast group” also ceased CPAP and oxygen at a shorter corrected GA (CGA).

Ceasing CPAP at Standard Criteria (Cicada): Why Infants Fail to Come Off CPAP Immediately

Table: Comparison of fast and slow weaning groups

Conclusion: PBs with lower GA and BWt in whom the history includes incomplete antenatal steroid coverage, prolonged ventilation with a PDA are less likely to come off CPAP in the first 2 attempts. If PBs fail to come off CPAP after 2 attempts, it may be prudent for them to remain on CPAP for at least another week before trialing off again.

Corresponding author: david.todd@act.gov.au

1. Todd et al. Methods of weaning preterm babies <30 weeks gestation off CPAP: A multicentre randomised controlled trial. Arch Dis Child Fetal Neonatal 2012: Vol 97(4) F236-240

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