Neonatal applications of nasal continuous positive airways pressure (NCPAP) include prevention of extubation failure,¹ apnoea of prematurity,² and as an alternative to intubation and ventilation in respiratory distress syndrome,³ in very preterm infants,⁴ and in exacerbations of chronic lung disease. On our neonatal unit we deliver all CPAP using the Infant Flow Driver (IFD) (EME Ltd, Brighton, UK). We were interested in how other units currently use the IFD and wean infants from NCPAP.

Between December 2003 and April 2004 we surveyed all 58 neonatal units with intensive care cots in the Northern Region of England. We posted a questionnaire and stamped addressed envelope to the unit nurse manager. We made a follow up telephone call to all units that did not respond and for incomplete or ambiguous replies. We obtained a 100% response rate. Table 1 summarises the main indications for NCPAP and weaning practices in 54 units that used the IFD.

Other indications cited were: chronic lung disease (five units); thoracic dystrophy (one unit); post-diaphragmatic hernia repair (one unit). Three units gave CPAP only through an endotracheal tube, and one surgical unit did not use CPAP in any form.

We found that briefly intubating, giving surfactant, then starting NCPAP is common in infants with severe respiratory distress syndrome and in very preterm infants. This is despite scant evidence to date that the practice decreases chronic lung disease or need for mechanical ventilation.⁵

The optimal method of weaning infants from NCPAP remains unanswered.⁵ We found that although some units try abrupt discontinuation of NCPAP, most wean on an ad hoc basis by gradually decreasing either time spent on the IFD or the CPAP pressure. Only three units (6%) had a weaning protocol, although most respondents (85%) would welcome formal weaning guidelines.

The wide variation in local practice undoubtedly reflects the lack of published trials. Formal comparisons of weaning regimens are necessary to minimise morbidity resulting from undertreatment and overtreatment with NCPAP.