Comparison of methods of Weaning from Nasal Continuous Positive Airway Pressure in Preterm Infants: A Randomized Controlled Trial

Objective: To compare the efficacy of different nasal continuous positive airway pressure (NCPAP) weaning strategies in preterm infants presenting with respiratory distress syndrome (RDS). Methodology: This randomised controlled trial was conducted at the Department of Paediatrics, Dr. Ziauddin University Hospital, Karachi, Pakistan, from July to December 2024. It included preterm infants with gestational ages between 28 to < 37 weeks and low birth weight (<2500 grams) presenting with RDS. Group-A underwent sudden weaning of NCPAP, Group-B had gradual weaning with time off NCPAP, and Group C underwent pressure weaning. Outcome measures included weaning success, total days on NCPAP and length of hospital stay. Data were analysed using IBM-SPSS Statistics, version 26.0. Results: Seventy-five infants participated, with 39 (52.0%) females, and a mean age of 3.35±3.49 hours. NCPAP weaning was successful in 69 (92.0%) cases. There was no significant difference in weaning success rates among different strategies (p=0.581). The day of NCPAP weaning initiation showed a significant correlation with weaning strategies (p<0.001). The successful weaning day was also significantly correlated with weaning strategies (p=0.001). Duration of NCPAP was significantly different between groups (p=0.002). Hospitalisation duration was significantly shorter in the sudden weaning group (8.52±5.65 days) compared to the gradual (12.32±5.73 days) and pressure weaning groups (11.80±5.55 days) (p=0.041). Conclusion: Infants subjected to sudden NCPAP weaning had a significantly shorter overall duration of NCPAP, leading to a significantly reduced total duration of hospitalisation compared to those undergoing gradual or pressure weaning. Success rates for sudden, gradual, and pressure NCPAP weaning varied but without significant differences.