ArticleChildren (Basel, Switzerland)2022
Noninvasive Ventilation in Preterm Infants: Factors Influencing Weaning Decisions and the Role of the Silverman-Andersen Score.
Article in Children (Basel, Switzerland), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed, 9 citations in OpenAlex.
- Association between 24-hour urine output during early non-invasive ventilation and short-term adverse outcomes in late preterm infants: a retrospective cohort study.Translational pediatrics · 2026Article
- Article
- Diaphragm Thickness and Contraction During Non-Invasive Ventilation: An Ultrasound Study.Children (Basel, Switzerland) · 2025Article
- Early successful weaning from continuous positive airway pressure in infants <32 weeks of gestation: predictors of success.Frontiers in pediatrics · 2025Article
- Special Issue: Advances in Healthcare for Neonates.Children (Basel, Switzerland) · 2023Article
- Inter-rater reliability of the Silverman and Andersen index-a measure of respiratory distress in preterm infants.PloS one · 2023Article
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Authors and funding
6 authors at 2 institutions in 2 countries.
Funding
Abstract
The factors influencing weaning of preterm infants from noninvasive ventilation (NIV) are poorly defined and the weaning decisions are often driven by subjective judgement rather than objective measures. To standardize quantification of respiratory effort, the Silverman-Andersen Score (SAS) was included in our nursing routine. We investigated the factors that steer the weaning process and whether the inclusion of the SAS would lead to more stringent weaning. Following SAS implementation, we prospectively evaluated 33 neonates born ≤ 32 + 0 weeks gestational age. Age-, weight- and sex-matched infants born before routine SAS evaluation served as historic control. In 173 of 575 patient days, NIV was not weaned despite little respiratory distress (SAS ≤ 2), mainly due to bradycardias (60% of days without weaning), occurring alone (40%) or in combination with other factors such as apnea/desaturations. In addition, "soft factors" that are harder to grasp impact on weaning decisions, whereas the SAS overall played a minor role. Consequently, ventilation times did not differ between the groups. In conclusion, NIV weaning is influenced by various factors that override the absence of respiratory distress limiting the predictive value of the SAS. An awareness of the factors that influence weaning decisions is important as prolonged use of NIV has been associated with adverse outcome. Guidelines are necessary to standardize NIV weaning practice.
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