Early Successful Weaning from Continuous Positive Airway Pressure in Infants <32 Weeks of Gestation: Predictors of Success

Lisa Marie Bünte ^1,2* Christina Walden ³ Jennifer Schlecht ⁴ Benedikt Bubl ¹ Mircea-Horia Popa-Todirenchi ¹ Susanne Tippmann ³ Julia Winter ³ Eva Mildenberger ³ André Kidszun ^1,3

• ¹ Division of Neonatology, Department of Pediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
• ² Graduate School for Health Sciences, University of Bern, Bern, Bern, Switzerland
• ³ Division of Neonatology, Center for Pediatric and Adolescent Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
• ⁴ Division of Pediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany

To identify demographic and clinical variables predictive of early successful weaning in preterm infants weaned off continuous positive airway pressure (CPAP).Single-center retrospective analysis of preterm infants < 32 0/7 weeks gestational age (GA) weaned off CPAP according to a standardized protocol April 2013 -March 2017.Infants were categorized into (1) early successfully weaned (Early-W) if weaned at the first attempt and (2) delayed weaned (Delayed-W) if more than one attempt was necessary. Potential predictor variables were predefined. Association with Early-W was analyzed by multivariable logistic regression with model selection using the Akaike information criterion (AIC). Model performance was evaluated using the area under the receiver operating characteristic (ROC-AUC).145 infants (79 [54.5%] were Early-W and 66 [45.5%] Delayed-W) with complete data sets were included in the analysis. A model of higher GA (odds ratio [OR] 1.66; 95% confidence interval [CI] 1.39, 2.03; p<0.001), present patent ductus arteriosus (PDA) (OR 0.41, 95% CI 0.16, 1.04; p=0.062) and higher median respiratory rate (RR) in the previous 12 hours (OR 0.36; 95% CI 0.16, 0.74; p=0.008) best predicted Early-W (ROC-AUC: 0.841).This study identified GA, PDA and median RR to predict early successful weaning in preterm infants weaned off CPAP. The predictive value of median RR in the 12 hours prior to CPAP cessation is considered a novelty requiring further prospective investigation, with RR being a clinical parameter commonly employed in routine practice and practical for everyday application.