339 - Duration of Continuous Positive Airway Pressure: Associations with Length of Stay and Oral Feeding Patterns in a Level IV Neonatal Intensive Care Unit

Publication Number: 339.4958

Caroline Massarelli, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Andrea Weintraub, Icahn School of Medicine at Mount Sinai, White or Caucasian, NY, United States; Douglas Bush, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Veniamin Ratner, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Courtney Juliano, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Background: Nasal continuous positive airway pressure (CPAP) is commonly used to provide noninvasive respiratory support for preterm infants. Traditionally, CPAP is discontinued once an infant is stable without it, but the timing of discontinuation varies widely. Current literature primarily addresses methods of CPAP weaning rather than timing. Evidence suggests CPAP may significantly benefit preterm lung development, prompting questions about the advantages of extending its use. However, prolonged CPAP use may lead to longer hospital stays, delayed initiation of oral feeding, and reduced engagement in developmental therapies.

Objective: To assess whether extended CPAP duration in preterm infants is associated with increased length of stay (LOS), older postmenstrual age (PMA) at discharge, and older PMA at achievement of oral feeds.

Design/Methods: We conducted a retrospective chart review of infants born at < 33 weeks gestational age (GA) between 2017–2022 in a Level IV NICU. During this period, guidelines promoting CPAP use until 34 weeks PMA and/or 1500g were implemented. Kruskal-Wallis tests examined the influence of study year on outcomes, and linear regression models assessed LOS, PMA at discharge, and PMA at full oral feeds.

Results: The study included 571 infants with a median GA 30.7 weeks (IQR 3) and birth weight 1375g (IQR 620). In our cohort, the median PMA at CPAP discontinuation significantly increased from 32.4 to 35.3 weeks (p < 0.001) and full oral feeds were achieved at significantly older median PMA from 35.7 to 37.7 weeks (p = 0.006) across the study period. Despite these changes, there was no significant difference in LOS or PMA at discharge following extended CPAP use. Importantly, linear regression modeling demonstrated that each additional week of CPAP use significantly extended LOS (p = 0.001), but only by 0.6 days or approximately 14 hours. Early wean to high-flow nasal cannula (HFNC) from CPAP was associated with both significantly longer LOS by 2.2 days (p < 0.001) and older PMA at discharge by 2.3 days (p=0.001).

Conclusion(s): This study demonstrated that extended time on CPAP had only a minor impact on LOS and PMA at discharge. While prolonged CPAP is associated with a later transition to full oral feeding, hospitalization duration is minimally affected. The use of HFNC as an intermediate respiratory support mode also significantly extends hospitalization, supporting prior evidence that direct wean to room air is preferable when feasible. Further study is needed to assess the potential impacts of extended CPAP duration and the optimal timing for discontinuation in preterm infants.

Table 1: Characteristics of the study population (N= 571)


Table 2: Analysis of Clinical Factors by Year


Table 3. Significant predictors of LOS, PMA at Discharge, and PMA at Full Oral Feeds (linear regression models)
B unstandardized coefficient, SE B standard error of B, β standardized coefficient, t t-statistic