700 - Identifying Risk Factors for Continuous Positive Airway Pressure Weaning Failure in Premature Infants

Publication Number: 4684.700

Ella Turley, University of Nebraska College of Medicine, Omaha, NE, United States; Elizabeth Lyden, University of Nebraska College of Medicine, Omaha, NE, United States; Eric S. Peeples, University of Nebraska Medical Center, Omaha, NE, United States

Background: Respiratory distress syndrome (RDS) affects nearly all infants born < 28 weeks and up to 30% born < 36 weeks, making it a leading cause of morbidity in preterm infants. Continuous positive airway pressure (CPAP) is an effective non-invasive treatment option for RDS, yet no universal, evidence-based guidelines exist for its management. Weaning CPAP once at 21% oxygen may improve some respiratory outcomes, but other relevant short-term functional outcomes have not yet been evaluated.

Objective: To compare short-term outcomes - including time to weaning off respiratory support, time to full oral feeding, and length of stay - between premature infants receiving CPAP for RDS who were weaned once at 21% oxygen compared with higher concentrations.

Design/Methods: This single-center retrospective study included infants with RDS born at < 32 weeks from 2014-2024. Those who died prior to CPAP wean, had major airway or pulmonary anomalies, or were weaned off of CPAP within 48 hours were excluded. Respiratory wean duration was defined as the time between weaning off of CPAP and weaning off of all respiratory support. Continuous and categorical variables were compared using t-tests and Fisher's exact tests. Censored outcomes (time to respiratory wean and full oral feeds) were analyzed using Kaplan-Meier and log rank tests. Multivariable models were performed using Cox proportional hazards models.

Results: Among the 298 infants included,138 were weaned at 21% and 160 at higher oxygen. Those weaned from CPAP at higher oxygen levels were born at lower gestational ages, had longer hospital stays, reached oral feeds later, and had higher rates of bronchopulmonary dysplasia (BPD) and home oxygen use (Table 1) in univariate analyses. After adjusting for gestational age at birth and number of surfactant doses, the 21% oxygen group was independently associated with shorter time to full oral feeds but not time to weaning off respiratory support (Table 2).

Conclusion(s): Infants weaned from CPAP at higher oxygen levels were born at lower gestational age and had longer hospitalizations and higher rates of BPD and home oxygen. Oxygen requirement at weaning did not independently predict respiratory wean duration but was associated with a difference in time to full oral feeds, warranting further study in a larger multi-center cohort.

Table 1. Demographics and Outcomes by Oxygen Concentration at time of Continuous Positive Airway Pressure (CPAP) Wean


Table 2. Multivariable Regression Analysis of Factors Associated with Time to Weaning Off Respiratory Support