Grant: Project Grant

Premature babies often need breathing support with a tube inserted directly into the windpipe. However, this can cause lung injury and result in long-term health complications. Another option is using nasal masks/prongs, believed to be gentler. Clinicians caring for preterm babies try to remove the breathing tube as soon as possible, replacing it with nasal breathing support. But up to one-third of the time, the breathing tube has to be put back in, and this failure is directly linked with health complications. We seek to improve the use nasal breathing support to increase the chances of successfully removing the breathing tube. Specifically, we want to know the pressure levels that should be used when starting nasal breathing support after the breathing tube is removed, which is currently unknown. Some small studies have suggested that using higher pressure levels on nasal breathing may be better, but this has not been proven conclusively. To address this dilemma, we will perform a study across 22 hospitals in Canada and compare two different pressures - higher vs. standard - on nasal breathing support, in relation to the pressures the baby was receiving through the breathing tube. During this 3.5-year study, approximately half of the hospitals will use higher pressures for all eligible babies, while the rest will use standard pressures (equal to the pressures given through the breathing tube) after the breathing tube is removed. At the end, we will check whether using higher pressures increases the chances of successfully removing the breathing tube. Additionally, at one hospital that will use higher pressures, we will check the heart function before and after breathing tube removal to make sure that higher pressures do not cause any difficulty in the heart's ability to pump blood. If higher pressures on nasal breathing support are shown to be better and safe, this will lead to immediate changes in the care of preterm babies that will improve outcomes.