155 - Flow and Grow: A Weaning Strategy for Extremely Preterm Babies on CPAP

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 155
Publication Number: 155.437

Sandra Leibel, University of California, San Diego School of Medicine, San Marcos, CA, United States; James Goodmar, UC San Diego Health, La Jolla, CA, United States; Samantha Hietalati, University of California, San Diego School of Medicine, San Diego, CA, United States; Katherine Weiss, University of California, San Diego School of Medicine, San Diego, CA, United States

Presenting Author(s)

Sandra Lawrynowicz Leibel, MD, MS (she/her/hers)

Associate professor
University of California, San Diego School of Medicine
San Marcos, California, United States

Background:

Non-invasive ventilation in neonates is a life-saving technology, however, most weaning strategies result in clinical instability and/or weaning failure. Many centers with the lowest rates of bronchopulmonary dysplasia don’t wean preterm infants off of CPAP until they’re 32-34 CGA. This may allow the positive air pressure to facilitate lung growth in a developing preterm infant.

Objective:

To compare ideal timing of weaning from non-invasive continuous positive pressure ventilation in infants born at < 30 weeks gestational age.

Design/Methods:

To determine the sample size for a prospective randomized clinical trial, we performed a retrospective chart review in babies less than 30 weeks GA from 4 level III NICUs in San Diego. We identified babies over a 6-month period that fit the GA criteria, were intubated for less than 4 weeks prior to extubation, were on any form of non-invasive positive pressure ventilation (CPAP, NIPPV) and did not have congenital anomalies or require surgical interventions. Babies were placed into 2 groups: those that remained on CPAP until 34 weeks GA and those that were weaned from CPAP prior to 34 weeks GA. Weaning failure was defined as having to go back to a higher level of respiratory support (low flow to high flow or CPAP; room air to any type of support). Clinical instability was defined as 50% more stimulation events (apnea, bradycardia, and/or desaturations) 72 hours after weaning from CPAP.

Results:

At the NICUs in Jacobs Medical Center, Rady Children’s Hospital, Scripps La Jolla and Rancho Springs Medical Center, 55 babies were identified. Twenty babies were on CPAP until 34 weeks CGA while 35 babies were weaned prior to that CGA. Weaning failure including clinical instability after weaning occurred in 19% of babies in the remain on CPAP group while weaning failure occurred in 70% of babies that were weaned prior to 34 weeks CGA.

Conclusion(s):

Weaning preterm babies from CPAP prior to 34 weeks CGA results in significantly higher rates of weaning failure. We aim to verify this data with a prospective, randomized clinical trial.