Effective Approaches & Strategies to Ease Off Nasal CPAP In Preterm Infants

Inclusion Criteria: * Born between 23 0/7 - 30 6/7 weeks GA * At least 26 0/7 weeks corrected GA. * On NCPAP for at least 24 hours * Stable on ≤0.3 FiO2 for at least 24 hours Initiation of study protocol, i.e., weaning from NCPAP, was started when infant met all of the following criteria for at least 24 hours: * Requiring NCPAP of 4-6 cm of H2O and FiO2 ≤0.3. * All babies \< 32 weeks corrected GA should have been loaded or already on maintenance caffeine (caffeine citrate 20 mg/kg as the loading and 5-10 mg/kg as the maintenance dose). * Stable respiratory system assessment (respiratory rate of \< 70/min, no significant chest retractions (sternal/ diaphragmatic), and baseline oxygen saturation \> 86%) and otherwise deemed clinically stable for weaning off non-invasive ventilation by medical team * If post-surgery, infant must be at least 2 weeks post-operative and off antibiotics with no concern or need for repeat surgery. * A documented hemoglobin of more than 8 g/dl within 7 days of initiation of the study. * Meeting "stability criteria" defined below: * The infant had to be tolerating a flow of no more than 2 liters NC on a FiO2 of 0.30 or less to keep oxygen saturations above 85% (should match what you wrote below in failure criteria)%. * Have a respiratory rate of less than 70 on average over 24 hours for more than 24 hours * The infant could have no significant chest recession (sternal/diaphragmatic) Exclusion Criteria: * Evidence of a hemodynamically or clinically significant (worsening respiratory status or pulmonary edema on chest x-ray) Patent ductus arteriosus, diagnosed either clinically or echocardiographically. * Any significant congenital abnormality (abnormalities affecting a major organ system, airway, or musculoskeletal system). * Hemodynamic/respiratory instability or currently being treated for suspected or proven sepsis (positive blood culture) * Grade IV intraventricular hemorrhage * Inability to obtain informed parental consent