ArticleFrontiers in pediatrics2026
Structured continuous positive airway pressure weaning standardizes discontinuation and reduces instability events.
Article in Frontiers in pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
Background/objectives: Continuous positive airway pressure (CPAP) is a cornerstone of neonatal respiratory support, yet weaning practices remain highly variable and largely experience-based. This study evaluated whether implementing a structured, stage-based CPAP-weaning protocol could standardize clinical decision-making and reduce exposure to poorly tolerated CPAP-off periods, using safety-relevant instability markers. Methods: In this single-centre interventional study with a historical control group, all neonates reaching ≥30 + 0 weeks corrected gestational age who received CPAP between March 2022 and February 2024 were included. The intervention introduced a seven-stage, pause-based CPAP-weaning protocol with predefined escalation criteria, bedside "monitor cards," and electronic documentation. Primary endpoints were daily episodes of oxygen desaturation (SpO₂ < 85%) and bradycardia (heart rate < 100 bpm). Secondary endpoints included stimulation frequency, duration of respiratory support, and adverse events. Results: A total of 344 neonates were analyzed (169 pre-implementation and 175 post-implementation), representing 2,950 CPAP-weaning days. Following implementation, the median number of bradycardia episodes per day decreased [3 [IQR 1-5] vs. 2 [IQR 1-5]; Conclusions: Implementation of a structured CPAP-weaning protocol was associated with fewer daily instability events without prolonging respiratory support. These findings most likely reflect improved safety and standardization of CPAP discontinuation rather than enhanced intrinsic respiratory stability, supporting the feasibility of protocolized weaning in routine NICU care.
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