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American Academy of Pediatrics
Article

Nasal Continuous Positive Airway Pressure Facilitates Extubation of Very Low Birth Weight Neonates

Rosemary D. Higgins, Susan E. Richter and Jonathan M. Davis
Pediatrics November 1991, 88 (5) 999-1003;
Rosemary D. Higgins
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Susan E. Richter
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Jonathan M. Davis
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Abstract

A prospective randomized trial was performed in 58 neonates comparing nasal continuous positive airway pressure (NCPAP) vs oxyhood following extubation of neonates weighing less than 1 kg. All neonates had been ventilated for the treatment of respiratory distress syndrome for at least 24 hours and weighed less than 1 kg at the time of extubation. Clinical criteria for elective extubation included improving pulmonary status, fraction of inspired oxygen (FIO2) ≤ 0.35, mean airway pressure ≤ 7 cm H2O, ventilator rate ≤ 20 breaths per minute, and weight at least 80% of birth weight. Informed consent was obtained and neonates were randomized to NCPAP or oxyhood following extubation. Success was defined as remaining free of additional ventilatory support for at least 5 days. Failure criteria included FIO2≥ 0.60 to maintain pulse oximetry ≥ 93%, PaCO2 ≥60 mm Hg, pH ≤ 7.23, or moderate to severe apnea. Results demonstrate that 22 (76%) of 29 neonates were successfully extubated to NCPAP while only 6 (21%) of 29 were successfully extubated to oxyhood (P < .0001). There were no differences in baseline characteristics between the two groups. Of the 23 neonates who failed oxyhood, 21 were then given a trial of NCPAP and 58% (12/21) remained extubated. Data indicate that using selected clinical criteria for elective extubation of neonates weighing less than 1 kg, NCPAP facilitates successful extubation.

  • mechanical ventilation
  • nasal continuous airway pressure
  • respiratory distress syndrome
  • very low birth weight neonates
  • extubation
  • Received October 1, 1990.
  • Accepted November 27, 1990.
  • Copyright © 1991 by the American Academy of Pediatrics
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Pediatrics
Vol. 88, Issue 5
1 Nov 1991
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Nasal Continuous Positive Airway Pressure Facilitates Extubation of Very Low Birth Weight Neonates
Rosemary D. Higgins, Susan E. Richter, Jonathan M. Davis
Pediatrics Nov 1991, 88 (5) 999-1003;

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Nasal Continuous Positive Airway Pressure Facilitates Extubation of Very Low Birth Weight Neonates
Rosemary D. Higgins, Susan E. Richter, Jonathan M. Davis
Pediatrics Nov 1991, 88 (5) 999-1003;
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  • Predictors of extubation readiness in preterm infants: a systematic review and meta-analysis
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  • A Randomized, Controlled Trial Comparing Two Different Continuous Positive Airway Pressure Systems for the Successful Extubation of Extremely Low Birth Weight Infants
  • Evidence-Based Approach to Change in Clinical Practice: Introduction of Expanded Nasal Continuous Positive Airway Pressure Use in an Intensive Care Nursery
  • Evaluation and Development of Potentially Better Practices to Prevent Chronic Lung Disease and Reduce Lung Injury in Neonates
  • A Prospective Randomized, Controlled Trial Comparing Synchronized Nasal Intermittent Positive Pressure Ventilation Versus Nasal Continuous Positive Airway Pressure as Modes of Extubation
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  • Randomised, controlled trial of nasal continuous positive airway pressure in the extubation of infants weighing 600 to 1250 g
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