Optimising Breathing Support at Extubation in Very Preterm Infants: A Clinical Study

Recruiting now · Not applicable

Conditions studied: Respiratory Distress Syndrome, Newborn, Respiratory Distress Syndrome in Premature Infant

In brief

Many babies born very preterm (\<32 weeks of pregnancy) require support to breathe from a breathing machine (mechanical ventilator) via a breathing tube. Although this keeps babies alive, it can damage their lungs. To reduce this damage, doctors and nurses try to change babies to gentler breathing support that does not require a breathing tube. This is usually done using a method called nasal continuous positive airway pressure (nCPAP) that uses a nosepiece to deliver breaths. This process of removing the breathing tube is called "extubation". Many babies will need the breathing tube put back in after extubation (for various reasons) and this is independently associated with poorer outcomes. This research study aims to compare two ways of performing extubation - both of which are already used regularly by doctors and nurses. The "standard extubation" approach involves taking a baby's breathing tube out first, then applying the nosepiece and starting nCPAP. The more recent approach, called "prePAP", involves applying the nosepiece and starting nCPAP before taking the breathing tube out. Previous research suggests that a prePAP approach may provide better support for babies during extubation. However, larger studies are required before this approach is more commonly used. This study is investigating whether extubating the baby with prePAP is better than extubating the baby without prePAP. The main question it aims to answer is: Does initiating nCPAP before extubation in very preterm babies reduce the fall in their oxygen levels post-extubation?

Key facts

Study ID

NCT07251790

Run by

Murdoch Childrens Research Institute

People needed

134

Starts

2026-05-04

Expected to finish

2028-03-31

Last updated by the study team

2026-05-19

Who can join

Age: any. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

• The infant is admitted to participating NICU
• The infant is born between 22+0 to 29+6 weeks gestational age
• The infant has been on a form of invasive mechanical ventilation for at least 4 hours
• The infant is being electively extubated for the first time from invasive mechanical ventilation to nCPAP
• The infant is clinically stable (as per clinical and research team consensus)
• The parent(s) or legal guardian(s) provides prospective informed consent.

You may not qualify if…

• The infant is born <22 weeks or >30 weeks gestational age
• The infant has a major congenital anomaly involving the cardiac, respiratory or gastrointestinal systems, or a known genetic syndrome or diagnosis that might affect respiratory course and outcomes
• The infant has severe pulmonary hypoplasia due to anhydramnios or oligohydramnios before 22 weeks in which the neonatal clinician anticipates that pulmonary hypoplasia related respiratory failure will be the major respiratory problem in early postnatal life
• The infant is receiving invasive mechanical ventilation via nasotracheal intubation
• The infant is planned for extubation to any other mode of non-invasive respiratory support than nCPAP, or no respiratory support
• Refusal of informed consent from the parent(s), or the infant does not have a guardian who can provide informed consent.

Where it is running

• The Royal Women's Hospital — Melbourne, Victoria, Australia (enrolling)
• Joan Kirner Women's and Children's Hospital — Saint Albans, Victoria, Australia (enrolling)

Full record on ClinicalTrials.gov

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