Nasal continuous positive airway pressure (NCPAP) is a form of respiratory support commonly used in the treatment of preterm infants. Potential risks of NCPAP include damage to the nose and leaking of air from the lungs. Infants on NCPAP require more nursing care and the use of extra equipment. However, potential complications of removing NCPAP from babies too early include increasing episodes of forgetting to breathe, increased oxygen needs, increased effort of breathing, the need to restart NCPAP and the need for a breathing tube with mechanical ventilation. Any of these complications can be seen as a "failure" and are potentially distressing to staff and family. The best way to withdraw NCPAP once it has been started is unknown. Options include simply stopping, weaning the pressure, increasing the time off NCPAP each day or combinations of both. A recent study has suggested that stopping the NCPAP all together once compared to having periods of time off NCPAP decreases the incidence of chronic neonatal lung disease and the length of hospital stay.
We aimed to determine the benefits and risks of different strategies used for the withdrawal of NCPAP in preterm infants who are stable and may be ready to have NCPAP withdrawn. This review identified three studies but, due to differences in the studies and the limited data available, the results could not be combined.
Infants who have their NCPAP pressure weaned to a predefined level and then stop NCPAP completely have less total time on NCPAP and shorter durations of oxygen therapy and hospital stay compared with those that have NCPAP removed for a predetermined number of hours each day. Clear criteria need to be established for the definition of stability prior to attempting to withdraw NCPAP and for the definition of failure to withdraw.