SynthesisBMJ paediatrics open2020
Weaning strategies for the withdrawal of non-invasive respiratory support applying continuous positive airway pressure in preterm infants: a systematic review and meta-analysis.
Synthesis in BMJ paediatrics open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
22 citing papers in PubMed, 2 syntheses or guidelines pooled it, 36 citations in OpenAlex.
- Application of the TIDieR checklist to improve the HFNC use in bronchiolitis management.European journal of pediatrics · 2024Pooled it
- High Flow Nasal Cannula for Weaning Nasal Continuous Positive Airway Pressure in Preterm Infants: A Systematic Review and Meta-Analysis.Neonatology · 2024Pooled it
- Higher (40%) versus lower (30%) FiOEuropean journal of pediatrics · 2025Trial
- Weight-adjusted rapid shallow breathing index during spontaneous breathing trial in mechanically ventilated preterm infants.Journal of perinatology : official journal of the California Perinatal Association · 2026Article
- Duration of noninvasive respiratory support in preterm infants: Association with gestational age and risk factors for delayed weaning.Journal of perinatology : official journal of the California Perinatal Association · 2026Article
- Duration of continuous positive airway pressure: associations with length of stay and oral feeding patterns in a level IV neonatal intensive care unit.Journal of perinatology : official journal of the California Perinatal Association · 2025Article
- Evaluating Clinically Directed Continuous Positive Airway Pressure to High Flow Nasal Cannula Transitions in Stable Preterm Infants Using Electrical Impedance Tomography: A Prospective, Observational Study.Pediatric pulmonology · 2025Observational
- Extending CPAP in stable preterm infants to increase lung growth and development as measured by pulmonary function testing.Seminars in perinatology · 2025Review
- Noninvasive Ventilation Strategies in Neonates.Indian pediatrics · 2025Review
- Diaphragm Thickness and Contraction During Non-Invasive Ventilation: An Ultrasound Study.Children (Basel, Switzerland) · 2025Article
- Short apneas and periodic breathing in preterm infants in the neonatal intensive care unit-Effects of sleep position, sleep state, and age.Journal of sleep research · 2025Observational
- Lung Volume Changes in Stable Preterm Infants Weaned From Nasal CPAP to High Flow: A Prospective Cohort Study.CHEST pulmonary · 2024Article
- The developmental phenotype of motor delay in extremely preterm infants following early-life respiratory adversity is influenced by brain dysmaturation in the parietal lobe.Journal of neurodevelopmental disorders · 2024Article
- Use of noninvasive mechanical ventilation weaning protocol in neonatal intensive care units in Brazil: a descriptive study.Revista paulista de pediatria : orgao oficial da Sociedade de Pediatria de Sao Paulo · 2023Article
- Predictive factors for extubation success in very low and extremely low birth weight preterm infants.Canadian journal of respiratory therapy : CJRT = Revue canadienne de la therapie respiratoire : RCTR · 2023Article
- Non-invasive ventilation in neonates: a review of current literature.Frontiers in pediatrics · 2023Review
- Neonatal respiratory support strategies-short and long-term respiratory outcomes.Frontiers in pediatrics · 2023Review
- A randomised trial comparing weaning from CPAP alone with weaning using heated humidified high flow nasal cannula in very preterm infants: the CHiPS study.Archives of disease in childhood. Fetal and neonatal edition · 2022Article
- Implementation of neurally adjusted ventilatory assist and high flow nasal cannula in very preterm infants in a tertiary level NICU.Pediatric pulmonology · 2022Article
- The Intertemporal Role of Respiratory Support in Improving Neonatal Outcomes: A Narrative Review.Children (Basel, Switzerland) · 2021Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe optimal method to wean preterm infants from non-invasive respiratory support (NIVRS) with nasal continuous positive airway pressure (CPAP) or high-flow nasal cannula is still unclear, and methods used vary considerably between neonatal units.
objectivePerform a systematic review and meta-analysis to determine the most effective strategy for weaning preterm infants born before 37 weeks' gestation from NIVRS.
methodEMBASE, MEDLINE, CINAHL, Google and Cochrane Central Register of Controlled Trials were searched for randomised controlled trials comparing different weaning strategies of NIVRS in infants born before 37 weeks' gestation.
resultsFifteen trials (1.547 infants) were included. With gradual pressure wean, the relative risk of successful weaning at the first attempt was 1.30 (95% CI 0.93 to 1.83), as compared with sudden discontinuation. Infants were weaned at a later postmenstrual age (PMA) (median difference (MD) 0.93 weeks (95% CI 0.19 to 1.67)). A stepdown strategy to nasal cannula resulted in an almost 3-week reduction in the PMA at successful weaning (MD -2.70 (95% CI -3.87 to -1.52)) but was associated with a significantly longer duration of oxygen supplementation (MD 7.80 days (95% CI 5.31 to 10.28)). A strategy using interval training had no clinical benefits. None of the strategies had any effect on the risk of chronic lung disease or the duration of hospital stay.
conclusionA strategy of gradual weaning of airway pressure might increase the chances of successful weaning. Stepdown strategy from CPAP to nasal cannula is a useful alternative resulting in an earlier weaning, but the focus should remain on continued weaning in order to avoid prolonged oxygen supplementation. Interval training should probably not be used.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.