Sudden Complete Versus Gradual Weaning from Nasal Continuous Positive Airway Pressure in Preterm Neonates: A Randomized Controlled Trial

Background: Continuous positive airway pressure (CPAP) is used as respiratory support in preterm neonates; however, the best weaning method has not yet been determined. In this study, we compared sudden complete and gradual weaning from nasal CPAP (NCPAP) in preterm newborns. Methods: This randomized controlled trial was conducted on 62 preterm neonates who were born with a gestational week of < 32 weeks and required NCPAP for at least 24 h. The neonates were stable on NCPAP at 0.21 FiO(2) and 5 cm H2O positive end-expiratory pressure. They were randomized into two groups of gradual and sudden weaning using random numbers sheet. The primary outcome was successful weaning at the first attempt. The secondary outcomes included the number of NCPAP weaning attempts, the need for mechanical ventilation (nasal and endotracheal), duration of NCPAP, oxygenation, and length of hospital stay. Results: According to the results, 80.6% of the patients in the sudden weaning group and 74.2% of the patients in the gradual weaning group were weaned successfully in the first attempt. However, there was no statistically significant difference between the two groups in this regard (P=0.54). Duration of NCPAP was significantly lower in the sudden weaning group, compared to that in the gradual weaning group (P<0.001). Numbers of NCPAP weaning attempts, the need for mechanical ventilation, duration of oxygenation, and hospital stay in the two groups were not significantly different. Conclusion: There was no difference between sudden complete and gradual weaning from NCPAP in terms of treatment success and complications. The selection of the appropriate technique may depend on available equipment and treatment costs.