Amatya Shaili, Rastogi Deepa, Bhutada Alok, Rastogi Shantanu
Division of Neonatology, Maimonides Infants & Children's Hospital, 4802 Tenth Ave, K-113, Brooklyn, NY, 11219, USA.
World J Pediatr. 2015 Feb;11(1):7-13. doi: 10.1007/s12519-014-0535-4. Epub 2014 Dec 29.
There is increased use of early nasal continuous positive airway pressure (NCPAP) to manage respiratory distress in preterm infants but optimal methods and factors associated with successful wean are not well defined. A systematic review was performed to define the corrected gestational age (CGA), weight to wean NCPAP and the methods associated with successful weaning of the NCPAP among preterm infants, along with factors affecting it.
Searches were made of PubMed using the keywords-NCPAP, CPAP, weaning, withdrawal, preterm, and infants from its inception to January 1st, 2014, for studies in all languages but limited to humans. Previous reviews (including cross references) were also searched. We included all randomized and quasi-randomized controlled trials where preterm neonates were randomized to different NCPAP weaning strategies. Details of CGA, weight and methods used for weaning NCPAP were extracted along with factors which affect its withdrawal.
Seven studies met the search criteria. The successful wean was at 32 to 33 weeks CGA and at 1600 g. Three different methods were used for weaning were sudden, gradual pressure wean and gradual graded time off wean. Criteria for readiness, success and failure to wean were defined. Factors affecting successful weaning were intubation, anemia, infection and gastro-esophageal reflux.
The successful wean was at 32 to 33 weeks CGA and 1600 g. Criteria for readiness, success and failure to wean are well defined. Sudden weaning may be associated with a shorter weaning time. Future trials are needed comparing weaning methods using defined criteria for readiness and success of NCPAP wean and stratify the results by gestational age and birth weight.
早期经鼻持续气道正压通气（NCPAP）在早产儿呼吸窘迫管理中的应用日益增加，但成功撤机的最佳方法及相关因素尚未明确界定。本系统评价旨在明确早产儿撤机时的矫正胎龄（CGA）、体重以及与成功撤机相关的方法，同时明确影响撤机的因素。
利用关键词“NCPAP”“CPAP”“撤机”“撤离”“早产”“婴儿”，在PubMed数据库中进行检索，检索时间范围从建库至2014年1月1日，检索所有语言但仅限于人类研究。同时检索既往综述（包括交叉参考文献）。纳入所有将早产新生儿随机分为不同NCPAP撤机策略的随机和半随机对照试验。提取撤机时的CGA、体重及NCPAP撤机方法的详细信息，以及影响撤机的因素。
7项研究符合检索标准。成功撤机的矫正胎龄为32至33周，体重为1600克。撤机采用了三种不同方法：突然撤机、逐渐降低压力撤机和逐渐分级间断撤机。明确了撤机的准备、成功及失败标准。影响成功撤机的因素包括插管、贫血、感染和胃食管反流。
成功撤机的矫正胎龄为32至33周，体重为1600克。撤机的准备、成功及失败标准已明确界定。突然撤机可能与较短的撤机时间相关。未来需要进行试验，比较使用明确的NCPAP撤机准备和成功标准的撤机方法，并按胎龄和出生体重对结果进行分层。
