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PEDIATRICS Vol. 112 No. 5 November 2003, pp. 1031-1038

A Randomized, Controlled Trial Comparing Two Different Continuous Positive Airway Pressure Systems for the Successful Extubation of Extremely Low Birth Weight Infants

Beatrice M. Stefanescu, MD^*, W. Paul Murphy, MD, Brenda J. Hansell, RT, CCRC^*, Mamta Fuloria, MD^*, Timothy M. Morgan, PhD and Judy L. Aschner, MD^*

^* Departments of Pediatrics
Anesthesia
Public Health Services, Wake Forest University School of Medicine, Winston-Salem, North Carolina

Objective. To determine whether the use of the Infant Flow continuous positive airway pressure (IF CPAP) system reduces the rate of extubation failure among extremely low birth weight (ELBW) infants (infants with birth weight <1000 g) when compared with conventional CPAP delivered with a conventional ventilator and nasal prongs.

Methods. A prospective, unmasked, randomized, controlled clinical trial was conducted in 162 eligible intubated ELBW infants who were hospitalized in 2 intensive care nurseries in Winston-Salem, North Carolina, between July 1997 and November 2000. Successful extubation was defined as no need for reintubation for any reason for at least 7 days after the first extubation attempt.

Results. The individual extubation success rates were 61.9% (52 of 84) in the conventional CPAP group and 61.5% (48 of 78) in the IF CPAP group. There were no significant differences in the extubation success rate in any birth weight subset between the 2 cohorts. The most common cause of extubation failure was apnea/bradycardia. Infants who were randomized to IF CPAP had fewer days on supplemental O₂ and shorter hospital stays.

Conclusions. Extubation failure is a common problem, occurring in nearly 40% of ELBW infants who require mechanical ventilation. IF CPAP was as effective but no more effective than conventional CPAP in preventing extubation failure among ELBW infants. New strategies are needed to identify predictors of extubation success and to treat apnea/bradycardia, the most common cause of extubation failure, thereby reducing the likelihood of prolonged intubation in this high-risk cohort of premature infants.

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Key Words: continuous positive airway pressure • extremely low birth weight • extubation • Infant Flow CPAP

Abbreviations: ELBW, extremely low birth weight • BPD, bronchopulmonary dysplasia • NCPAP, nasal continuous positive airway pressure • IF, Infant Flow • BW, birth weight • FIO₂, fraction of inspired oxygen • NIPPV, nasal intermittent positive pressure ventilation

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Received for publication Jan 13, 2003; Accepted Apr 24, 2003.

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