{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T22:37:39Z","timestamp":1773268659244,"version":"3.50.1"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background\/objectives<\/jats:title>\n                    <jats:p>Continuous positive airway pressure (CPAP) is a cornerstone of neonatal respiratory support, yet weaning practices remain highly variable and largely experience-based. This study evaluated whether implementing a structured, stage-based CPAP-weaning protocol could standardize clinical decision-making and reduce exposure to poorly tolerated CPAP-off periods, using safety-relevant instability markers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this single-centre interventional study with a historical control group, all neonates reaching \u226530\u2009+\u20090 weeks corrected gestational age who received CPAP between March 2022 and February 2024 were included. The intervention introduced a seven-stage, pause-based CPAP-weaning protocol with predefined escalation criteria, bedside \u201cmonitor cards,\u201d and electronic documentation. Primary endpoints were daily episodes of oxygen desaturation (SpO\u2082\u2009&amp;lt;\u200985%) and bradycardia (heart rate &amp;lt; 100\u2005bpm). Secondary endpoints included stimulation frequency, duration of respiratory support, and adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 344 neonates were analyzed (169 pre-implementation and 175 post-implementation), representing 2,950 CPAP-weaning days. Following implementation, the median number of bradycardia episodes per day decreased [3 [IQR 1\u20135] vs. 2 [IQR 1\u20135];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0004], as did oxygen desaturations [34 [IQR 11\u201376] vs. 30 [IQR 9\u201367];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.021]. Stimulation frequency, CPAP duration, and NICU length of stay remained unchanged. Air leak syndromes occurred less frequently after implementation (13% vs. 4%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.011). Protocol adherence was consistently high throughout the study period.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Implementation of a structured CPAP-weaning protocol was associated with fewer daily instability events without prolonging respiratory support. These findings most likely reflect improved safety and standardization of CPAP discontinuation rather than enhanced intrinsic respiratory stability, supporting the feasibility of protocolized weaning in routine NICU care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1776103","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T06:50:36Z","timestamp":1773211836000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Structured continuous positive airway pressure weaning standardizes discontinuation and reduces instability events"],"prefix":"10.3389","volume":"14","author":[{"given":"Philipp","family":"Deindl","sequence":"first","affiliation":[{"name":"Department of Neonatology and Pediatric Intensive Care Medicine, University Children\u2019s Hospital, University Medical Center Hamburg-Eppendorf","place":["Hamburg, Germany"]},{"name":"Department of Pediatrics and Adolescent Medicine, Hospital of L\u00fcneburg","place":["L\u00fcneburg, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juliane","family":"Nowotni","sequence":"additional","affiliation":[{"name":"Department of Neonatology and Pediatric Intensive Care Medicine, University Children\u2019s Hospital, University Medical Center Hamburg-Eppendorf","place":["Hamburg, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hanna","family":"Maruhn","sequence":"additional","affiliation":[{"name":"Department of Neonatology and Pediatric Intensive Care Medicine, University Children\u2019s Hospital, University Medical Center Hamburg-Eppendorf","place":["Hamburg, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eik","family":"Vettorazzi","sequence":"additional","affiliation":[{"name":"Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf","place":["Hamburg, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dominique","family":"Singer","sequence":"additional","affiliation":[{"name":"Department of Neonatology and Pediatric Intensive Care Medicine, University Children\u2019s Hospital, University Medical Center Hamburg-Eppendorf","place":["Hamburg, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mandy","family":"Lange","sequence":"additional","affiliation":[{"name":"Department of Neonatology and Pediatric Intensive Care Medicine, University Children\u2019s Hospital, University Medical Center Hamburg-Eppendorf","place":["Hamburg, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"673","DOI":"10.1164\/rccm.200306-761OC","article-title":"A prospective, controlled trial of a protocol-based strategy to discontinue mechanical 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