OBJECTIVE: To determine the better approach for weaning preterm infants from 
nasal continuous positive airway pressure (NCPAP) with or without transitioning 
to nasal cannula (NC).
DESIGN/METHODS: This is a randomized, open label, controlled trial. Preterm 
infants born at ≥28 weeks gestation who were clinically stable on NCPAP of 5 cm 
H(2)O with FiO(2)<0.30 for at least 24 h were randomly assigned to one of 2 
groups. The no-NC group were kept on NCPAP until they were on FiO(2)=0.21 for 24 
h, and then were weaned off NCPAP completely without any exposure to NC. If they 
met failing criteria, NCPAP was re-instituted. The NC-group was weaned off NCPAP 
when FiO(2) was ≤0.30 to NC (2 L/min) followed by gradual weaning from oxygen. 
Infants who failed NC were supported back with NCPAP for 24 h before making a 
second attempt of NC.
RESULTS: Sixty neonates were enrolled; 30 in each group. The two groups were 
similar in birthweight, gestational age, sex, antenatal steroids, mode of 
delivery, use of surfactant and xanthines, and duration of mechanical 
ventilation. After randomization, the no-NC group had fewer days on oxygen 
[median (interquartile range): 5 (1-8) vs 14 (7.5-19.25) days, p<0.001] and 
shorter duration of respiratory support [10.5 (4-21) vs 18 (11.5-29) days, 
p=0.03]. There were no differences between groups regarding success of weaning 
from NCPAP.
CONCLUSIONS: Weaning preterm infants from NCPAP to NC is associated with 
increased exposure to oxygen and longer duration of respiratory support.