Withdrawal of neonatal continuous positive airway pressure: Current practice in Australia

Background: Continuous positive airway pressure (CPAP) is a widely accepted method of respiratory support used in the care of preterm infants. It remains unknown as to what is the best strategy for the withdrawal of CPAP once it has been commenced. The aim of the present survey was to establish the current practices for withdrawal of nasal CPAP used by Australian neonatologists. A secondary aim was to establish what criteria clinicians use as an indicator for failure off CPAP. Methods: Surveys were sent to all 124 Australian neonatologists identified by the list of centers in the Australia and New Zealand Neonatal Network. Results: A total of 124 surveys were sent; 86 (69%) replies were received, of which 84 (68%) of the respondents had completed the questionnaire. Seventy-one percent of respondents used a graded-time-off CPAP. The majority of babies for whom they used graded-time-off CPAP were deemed to be chronic (79%) or had chronic neonatal lung disease (73%). A total of 74% of respondents had the level of CPAP gradually reduced. Conclusions: At least 48% of Australian neonatologists use graded-time-off CPAP. At least 50% of Australian neonatologists wean the level of CPAP prior to cessation. Neonatologists have similar criteria for recommencing CPAP, with the majority considering increased oxygen requirement, increased work of breathing, increased frequency of apnea and increased severity of apnea important indicators.