OBJECTIVE: To compare extubation failure rate with two ranges of nasal continuous positive airway pressure (NCPAP) in oxygen dependent preterm infants. STUDY DESIGN: Preterm infants of birth weight 500 to 1,000 g and gestational age 23 to 30 weeks, extubated for the first time during the first 6 weeks while requiring fraction of inspired oxygen => 0.25, were randomly assigned to a NCPAP range of 4 to 6 (low NCPAP) or 7 to 9 (high NCPAP) cmH2O. RESULTS: Infants were randomized to low (n = 47) or high NCPAP (n = 46) at day 16.3 +/- 14.7 and 15.5 +/- 12.4, respectively. Rates of extubation failure per criteria (24% versus 43%, p = 0.04, OR and 95% CI 0.39 (0.16 to 0.96)) and re-intubation (17% versus 38%, p = 0.023, 0.33 (0.016 to 0.85)) within 96 hours were significantly lower in the high- compared with the low NCPAP group. This was mainly due to a strikingly lower failure rate in the 500 to 750 g birth weight strata. Duration of ventilation, bronchopulmonary dysplasia, or severe bronchopulmonary dysplasia did not differ significantly. No infant developed pneumothorax during 96 hours post-extubation. CONCLUSIONS: Extubation failure in preterm infants with residual lung disease was lower with NCPAP range of 7 to 9 compared with 4 to 6 cmH2O. These findings suggest the need for higher distending pressure post-extubation in the more immature infants who are still oxygen dependent.

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