Comparision of Gradual Versus Sudden Weaning of Preterm Neonates from Nasal CPAP

Background: Advantages and disadvantages of CPAP are well known but ideal strategy of weaning from CPAP is still unknown. Removing neonate from CPAP may lead to increased O₂ requirement, increased work of breathing, need to restart CPAP. Hence safe weaning methods are required to prevent neonatal mortality and morbidity.

Objective: To compare gradual versus sudden weaning of preterm neonates from nasal CPAP.

Methods: Preterm neonates (<37weeks, <2.5kg) on CPAP were included; those with major malformations & air leaks were excluded. Neonates ready to be weaned were randomized. If the neonate was in ‘sudden’ weaning group, the baby was directly kept off CPAP for next 72 hours. If the neonate was in ‘gradual’ weaning group, the neonate was kept off CPAP for predetermined hours each day. All babies were closely monitored. If the neonates developed distress while weaning, they were put back on CPAP.

Results: Out of 91 neonates, 46 (50.5%) were weaned by sudden weaning, while 45 babies (49.5%) were weaned gradually. Among the 77 babies (84.6%) who succeeded weaning, 44 (48.3%) were from the gradual weaning group as compared to 33 (36.2%) in the sudden weaning group. The chi-square statistic was 11.8476 (p < 0.05). Failure rate was more (14.2%) in the sudden weaning group (p < 0.05). Success rate was more (58.2%) in babies with birth weight 1.5-2.5kgs and gestational age of 32-37 weeks (58.2%) (p value <0.01).

Conclusions: Gradual weaning was found to be better than sudden weaning. Success was more in babies > 1.5 kg & >32 weeks.