Duration of apnoea before start of backup ventilation during nCPAP in extremely preterm infants and time spent within the SpO2 target: a randomised cross-over study

Clinical Snapshot

Key Findings

• P Value: 0.88

• Effect Size: Mean difference: -0.3% (not clinically significant)

• Primary Outcome: Time spent within SpO2 target range: 66.9% (AD 4) vs 67.2% (AD 16)

• Nnt Or Sensitivity: No clinically meaningful benefit demonstrated; higher backup ventilation rate with AD 4

• Confidence Interval: Not reported in abstract

Clinical Application

Highly feasible - requires only ventilator setting adjustment, no additional equipment or training Relevant to Australian NICU practice; aligns with ANZNN registry population characteristics and standard nCPAP protocols used across Australian tertiary centres Extremely preterm infants <28 weeks gestation requiring nCPAP with backup ventilation in Australian NICUs

Abstract

OBJECTIVE: Central apnoea due to immaturity of the respiratory drive constitutes the main cause of frequent and prolonged desaturations in extremely preterm (EPT) infants <28 weeks. We investigated the impact of varying the duration of apnoea before backup ventilation (BUV) on the measures of oxygenation in EPT infants during nasal continuous positive airway pressure (nCPAP) therapy. DESIGN: Single-centre randomised cross-over trial. SETTING: Level 3 neonatal intensive care unit. PATIENTS: 24 EPT infants on nCPAP with BUV. MAIN OUTCOME MEASURES: The primary outcome was the time spent within a predefined oxygen saturation (SpO2) target (88%-95% or ≥88% with fraction of inspired oxygen (FiO2) =0.21) during start of BUV after 4 s of apnoea duration (AD 4) or 16 s of apnoea duration (AD 16) RESULTS: The study was successfully completed in 22 children (median gestational age 24+5 weeks, birth weight 628 g, postnatal age 48 days). Mean time spent within the SpO2 target didn't differ between AD 4 and AD 16 (66.9% vs 67.2%, p=0.88). There were no differences in the time below or above the SpO2 target, prolonged (>30 s, >60 s, >120 s) and severe (<80%, <70%) episodes of hypoxaemias and cerebral tissue oxygenation. Mean FiO2, mean airway pressure, transcutaneous carbon dioxide pressure, heart rate and respiratory frequency did not differ while the rate of BUV was significantly higher during AD 4. CONCLUSION: Reducing the time of apnoea until start of BUV didn't improve the time spent within the SpO2 target in respiratory unstable EPT infants. Our data demand intensified efforts to specify these settings of non-invasive respiratory support that better achieve this important clinical goal. TRIAL REGISTRATION NUMBER: DRKS00031911.

References

1. 1.Ströbele, S., Jung, T., Kraft, D., Forsteneichner, N., Mair, E.-M., Schiefele, L., Schmid, S., Waitz, M., Linhoff, V., Westhoff, A., Dreyhaupt, J., Sohrabi, K., & Ehrhardt, H. (2026). Duration of apnoea before start of backup ventilation during nCPAP in extremely preterm infants and time spent within the SpO2 target: a randomised cross-over study. Archives of Disease in Childhood - Fetal and Neonatal Edition. https://doi.org/10.1136/archdischild-2025-328734